Cardiology

Question 1

What are the systolic murmurs?

Answer 1

Aortic stenosis
HOCM
MVP

Question 2

Describe an aortic stenosis murmur

Answer 2

Crescendo- decrescendo systolic murmur at the right 2nd intercostal space
Radiation to the carotid

Question 3

Describe the murmur that is heard with hypertrophic cardiomyopathy

Answer 3

Crescendo-decrescendo systolic murmur

Question 4

What is a mitral valve prolapse murmur? Why does it happen?

Answer 4

A midsystolic murmur that is best heard at the left 5th intercostal space at the midclavicular line with a midsystolic click

Occurs because there are weak valve leaflets due to chordae tendonae. When the heart is in systolic and increases in pressure, the prolapsed area bows back into the atria and make the click noise (which is why its mid-systolic and not early systolic)

Question 5

Describe a mitral regurgitation murmur

Answer 5

holosystolic blowing murmur that is best heard at the left 5th ICS along the mid-clavicular line in the left lateral decubitus position (because the heart is closer to the chest wall)

Radiation to the axilla

Question 6

What will a VSD sound like?

Answer 6

A harsh murmur at the left 4th ICS parasternally

The smaller the diameter of the VSD, the greater the intensity

Question 7

What are the diastolic murmurs?

Answer 7

Aortic Regurgitation
Mitral Stenosis, Tricuspid stenosis
PDA (continuous)

Question 8

Describe an Aortic regurgitation murmur

Answer 8

Decrescendo blowing murmur heard at the right 2nd ICS with possible radiation to the left sternal border

Due to turbulence of flow

Question 9

Describe a mitral stenosis murmur

Answer 9

A diastolic decrescendo murmur with an opening snap; best heard at the 5th ICS midclavicular line

Question 10

What effect does squatting and passive leg raise have on the intensity of murmurs?

Answer 10

Squatting and leg raise will increase the amount of blood that reaches the heart- increase in preload

The stroke volume of the heart is increased

Intensity of ALL murmurs are increased EXCEPT For HOCM And MVP

Question 11

Why is the intensity of HOCM and MVP decreased with squatting and leg raising?

Answer 11

In HOCM the increased volume pushes the septum out of the way, opening up the space and resolving the murmur

MVP: the valve is too floppy with the increase in blood flow making the murmur shorter

Question 12

What effect does standing and valsalva have on murmurs?

Answer 12

Standing and valsalva decreases venous return which decreases the preload and the stroke volume

Decreases all murmurs EXCEPT HOCM and MVP- they do better with less blood flow

Question 13

What effect does the handgrip maneuver have on Aortic Stenosis?

Answer 13

There is increased afterload and decreased stroke volume

This leads to decreased forward flow

Question 14

What effect does the handgrip maneuver have on HOCM and MVP?

Answer 14

Since there is decreased stroke volume, there is more blood that is left in the ventricle which is worse for both of these murmurs

Question 15

What effect does the handgrip maneuver have on mitral regurge?

Answer 15

increases the intensity because there is more blood to flow back into the atria

Question 16

What does the handgrip maneuver have on aortic stenosis?

Answer 16

The aortic pressure is high which increases back flow and increases the sound of the murmur

Question 17

What murmur radiates to the axilla?

Answer 17

Mitral regurgitation

Question 18

What murmur radiates to the carotids?

Answer 18

Aortic stenosis