Heart Murmurs

Question 1

What are left systolic murmurs

Answer 1

aortic stenosis

mitral regurgitation

Question 2

what are left diastolic murmurs

Answer 2

aortic regurgitation

mitral stenosis

Question 3

what do you auscultate for aortic stenosis

Answer 3

aortic valve

both carotids

Question 4

what do you auscultate for mitral stenosis

Answer 4

mitral valve (apex), roll onto left side and hold breath on expiration, use bell

Question 5

what do you auscultate for mitral regurgitation

Answer 5

mitral valve and axilla

Question 6

what do you auscultate for aortic regurgitation

Answer 6

ask patient to lean forward, auscultate left lower sternal edge and hold breath on expiration

Question 7

What is heard in aortic stenosis plus fts

Answer 7

ejection systolic
radiates to carotids
louder on expiration

slow rising pulse
narrow pulse pressure

Question 8

What murmurs are heard loudest on inspiration

Answer 8

Right sided murmurs
pulmonary stenosis
tricus regurg

Question 9

What is heard in mitral stenosis

Answer 9

mid-late diastolic murmur
best heard on expiration
loud S1
opening snap

haemoptysis
sob

Question 10

what is heard in mitral regurg

Answer 10

pansystolic/ holosystolic
high pithced, blowing

Question 11

what is heard in aortic regurg

Answer 11

early diastolic murmur
high pitched blowing

collapsing
wide pulse pressure
Quincke’s sign - nailbed pulsation
De musset sign - head bobbing

Question 12

what murmur is late systolic

Answer 12

mitral valve prolapse
coarctation of aorta

Question 13

Innocent murmurs examples

Answer 13

Venous hums - continuos blowing

Still’s murmur - low pitched, lower left sternal edge

Question 14

ejection systolic murmurs

Answer 14

aortic stenosis
HOCM
pulmonary stenosis
ASD
tetralogy of fallot

Question 15

VSD murmur

Answer 15

pansystolic murmur
harsh

Question 16

What is heard in HOCM

Answer 16

ejection systolic murmur, inc w valsalva manoevure n decrease on squatting
S4

Question 17

innocent ejection murmur fts

Answer 17

soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
may vary with posture
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child

Question 18

Heart sounds what is S1

Answer 18

closure of mitral and tricuspid valves
soft if long PR or mitral regurgitation
loud in mitral stenosis

Question 19

S2 heart sounds heard in?

Answer 19

closure of aortic and pulmonary valves

soft in aortic stenosis
splitting during inspiration is normal

Question 20

S3 heart sounds heard in?

Answer 20

considered normal if < 30 years old (may persist in women up to 50 years old)
heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

Question 21

S4 heart sounds heard in?

Answer 21

may be heard in aortic stenosis, HOCM, hypertension
caused by atrial contraction against a stiff ventricle
therefore coincides with the P wave on ECG

in HOCM a double apical impulse may be felt as a result of a palpable S4

Question 22

what is heard in atrial septal defect

Answer 22

splitting of 2nd heart
ejection systolic