Cardiac Murmurs

Question 1

inspiration

Answer 1

↑ venous return

Question 2

hand grip

Answer 2

↑ afterload

Question 3

valsalva (phase 2), stand up

Answer 3

↓ preload

Question 4

squatting

Answer 4

↑ venous return, ↑ preload, ↑ afterload

Question 5

Aortic Stenosis

Answer 5

Systolic

crescendo-decresendo, ejection murmur
loudest: heart base
Sx: syncope, angina, dyspnea on exertion

Question 6

Mitral Regurg

Answer 6

Holosystolic

high pitched, “blowing”
loudest: apex, radiates to axilla

often 2° ischemia, MVP, LV dilation

Question 7

Aortic Regurg

Answer 7

Diastolic

decrescendo, high pitched, "blowing"
Wide PP (head bobbing)
loudest: pt sits up & leans forward

Question 8

Mitral Stenosis

Answer 8

Diastolic

after opening snap
delayed rumbling mid-late diastolic murmur
Severity? less time between S2 & OS

-> LA dilation -> compression of recurrent laryngeal n. -> hoarsness

Question 9

S3

Answer 9

after S2

rapid ventricular filling against a complaint (saggy) ventricle
“sloshes around”
dilated ventricle 2° AR, MR, or systolic/HFrEF

Question 10

S4

Answer 10

before S1

atrial kick against a stiff ventricle
hypertrophy 2° diastolic/HFpEF

Question 11

loud P2

Answer 11

↑ pulm artery pressure (Pulm HTN)