Cardio

Question 1

Likely benign systolic murmur if..

Answer 1

Negative cardio history
lower grade less than three or four
no radiation beyond the precordium (chest)
S1, S2 intact
no heave or thrill
PMI within normal limits
soften or disappears with supine to stand position change

Question 2

Likely pathologic systolic murmur if…

Answer 2

Abnormal cardio history
higher grade greater than 4
Radiation beyond the precordium to neck, axilla or other areas
S1 or S2 not heard
With thrill or heave
PMI displaced
increases in intensity with supine to stand position change

Question 3

Murmur radiates to the neck

Answer 3

Think aortic valve then when did you hear it? Systolic or diastolic phase?

Question 4

Murmur radiates to the axilla

Answer 4

Thank mitral valve. Then when did you hear it during systole or diastole?

Question 5

Delayed carotid upstroke

Answer 5

Calcified aortic stenosis.

Carotid upstroke or pulse should be almost simultaneous to S1 or S2 sounds

Question 6

Carotid bruit

Answer 6

Usually softer, often unilateral, different sound & tone than hurt in chest

Question 7

Radiating murmur

Answer 7

Often louder, bilateral, same sound and timing that is found in the chest.

Aortic murmur usually heard with radiation to the neck. Radiation may or may not always be present.