Cardiac murmurs

Question 1

what are the systolic murmurs

Answer 1

1. aortic stenosis
2. mitral regurg
3. hypertrophic cardiomyopathy
4. mitral value prolapse
5. atrial septal defect
6. ventricular septal defect

Question 2

what are the diastolic murmurs

Answer 2

1. aortic regurg

2. mitral stenosis

Question 3

what does the pt have if you hear a continuous murmur

Answer 3

patent ductus arteriosus, machine-like in interscapular region (posteriorly)

Question 4

crescendo-decrescendo

• at RUSB, A2 soft & delayed
• at mid-left sternal border

Answer 4

• aortic stenosis (most common cause is degenerative calcifications of the leaflets)
• hypertrophic cardiomyopathy (at mid-left sternal border)

Question 5

holosystolic murmur

• at apex and radiates to axilla
• at left sternal border

Answer 5

mitral regurg (at apex and radiates to axilla)

VSD (at left sternal border)–> the smaller the VSD the louder the murmur

Question 6

midsystolic click followed by late systolic murmur

Answer 6

mitral valve prolapse

Question 7

midsystolic with wide and fixed splitting of S2

Answer 7

atrial septal defect

Question 8

decrescendo at LUSB (Valvular), RUSB (aortic root)

Answer 8

aortic regurg

Question 9

opening snap followed by middiastolic rumble with presystolic accentuation

Answer 9

mitral stenosis

Question 10

why would you hear an S3

Answer 10

associated with increased filing pressures

• ventricular volume overload
• mitral regurg
• heart failure
• dilated ventricles

(can potentially be normal)

Question 11

why would you hear an S4

Answer 11

associated with high atrial pressures

-ventricular noncompliance (hypertrophy)

Question 12

when are S3 and S4 best heard

Answer 12

• bell of the stethoscope over cardiac apex
• pt in left lateral decubitus position
• at end expiration