Heart Murmurs

Question 1

Crescendo-decrescendo murmur heard best at the right second intercostal space with radiation to the carotids

Answer 1

Aortic Stenosis

Question 2

Holosystolic murmur heard best at the cardiac apex with radiation to the axilla

Answer 2

Mitral regurgitation

Question 3

Midsystolic click + Holosystolic murmur heard best at the cardiac apex with radiation to the axilla

Answer 3

Mitral valve prolapse

Question 4

Harsh holosystolic murmur at the left sternal border

Answer 4

Ventricular septal defect

Question 5

“Decrescendo murmur at the right or left second intercostal space”

Answer 5

Aortic regurgitation

Question 6

Opening snap with diastolic rumble heard best at the cardiac apex

Answer 6

Mitral stenosis

Question 7

“plop with diastolic rumble”

Answer 7

Atrial Myoxma

Question 8

“Continuous machine-like murmur”

Answer 8

patent ductus arteriosis

Question 9

Wide FIXED splitting

Answer 9

atrial septal defect

Question 10

Name two reasons for wide splitting

Answer 10

1. pulmonary stenosis

2. Right bundle branch block

Question 11

Name two reasons for paradoxical splitting

Answer 11

1. Left bundle branch block

2. aortic stenosis

Question 12

When does an S3 occur and why?

Answer 12

Right after S2. Due to volume excess

Question 13

Name reasons for S3

Answer 13

Eccentric hypertrophy (back flow, dilated cardiomyopathy), RAAS over-activation (fluid overload)  
normal in children, athletes and pregnant women

Question 14

When does an S4 occur and why?

Answer 14

It occurs right before S1 and represents pressure excess

Question 15

Name reasons for S4

Answer 15

concentric hypertrophy, stiffening of LV wall,

chronically increased afterload due to hypertension, aortic stenosis, HOCM

Question 16

Which maneuvers DECREASE preload? (2)

Answer 16

Valsalva, standing,

Question 17

Which maneuvers INCREASE preload? (2)

Answer 17

passive leg raise, squatting

Question 18

Which maneuvers INCREASE afterload?

Answer 18

handgrip, rapid squatting

Question 19

Name 7 causes of systolic mumurs

Answer 19

Aortic stenosis
Pulmonary stenosis
Mitral regurgitation
Tricuspid regurgitation,
VSD
HOCM
mitral valve prolapse

Question 20

Name 3 causes of diastolic murmurs?

Answer 20

aortic regurgitation
mitral stenosis
atrial myoxma

Question 21

What would happen to aortic stenosis murmur during standing?

Answer 21

Decrease in intensity due to decreased preload (less blood flow through stenotic vessel)

Question 22

What would happen to aortic stenosis murmur during handgrip?

Answer 22

Decrease in intensity because you have less flow (less turbulence) so quieter murmur

Question 23

What would happen to aortic stenosis murmur if you administered fluids

Answer 23

Increase in intensity because of increased preload

Question 24

What would happen to mitral regurgitation murmur if you raised your legs?

Answer 24

Increased intensity of the murmur because increased preload means more backflow

Question 25

What would happen to mitral regurgitation murmur during handgrip?

Answer 25

increase because increased afterload increases backflow

Question 26

What would happen to an aortic regurgitation murmur if you did Valsalva maneuver?

Answer 26

it would decrease in intensity because you are decreasing preload to the heart and thus decreasing backflow of blood

Question 27

What would happen to aortic regurgitation murmur if you squatted rapidly?

Answer 27

It would increase in intensity because more blood flowing backward from increased afterload

Question 28

What would happen to HOCM murmur if you were to stand?

Answer 28

it would INCREASE in intensity because you are decreasing preload (increased volume pushes l. hypertrophy out of the way to create less obstruction)

Question 29

What would happen to HOCM murmur during handgrip?

Answer 29

it would DECREASE because you’d have such little flow through that the murmur would become quieter.

Question 30

What would happen to mitral valve prolapse if you did handgrip maneuver?

Answer 30

it would increase intensity of murmur becuase increased afterload makes it preferential for fluid to flow backward, making mitral valve prolapse simialr to mitral regurgitation

Question 31

What would happen to mitral valve prolapse murmur if you gave nitrates?

Answer 31

it would INCREASE in intensity because of decreased preload the leaflets are more likely to prolapse