Heart Murmurs

Question 1

Normal Heart Sounds (S1 and S2)

Answer 1

• S1 is the “lub” sound, marking the start of ventricular systole with the closure of the mitral and tricuspid valves.
  • S2 is the “dub” sound, signaling the end of systole with the closure of the aortic and pulmonic valves.
  • S2 can split into A2 (aortic) and P2 (pulmonic) components, especially during inspiration.

Question 2

Additional Heart Sounds:

Answer 2

S3 (Third Heart Sound):** Normal in children and young adults, best heard at the apex in a recumbent position. It is sometimes associated with heart failure in older patients.

• S4 (Fourth Heart Sound): Typically abnormal and signifies atrial contraction against a stiff ventricle. Can be heard in athletic children due to physiologic hypertrophy.

Question 3

Gallops

Answer 3

A quadruple rhythm consists of both the S3 and S4 heart sounds.

Question 4

A summation gallop

Answer 4

occurs when S3 and S4 are present and can sometimes sound like a single mid-diastolic sound, common in conditions with rapid heart rates such as in infants.

Question 5

Murmurs

Answer 5

Innocent murmurs:** Such as Still’s murmur, which is vibratory or musical, common in healthy children

Question 6

Mitral Regurgitation

Answer 6

High-pitched and blowing, best heard at the apex, and often has an accompanying S3.

Question 7

Aortic Stenosis

Answer 7

A mid-systolic murmur best heard over the aortic area.

Question 8

Pulmonary Stenosis:

Answer 8

Has a crescendo-decrescendo pattern and radiates from the pulmonic area.

Question 9

Aortic Regurgitation

Answer 9

A blowing, high-pitched, early diastolic murmur heard with the diaphragm at the lower left sternal border when the patient leans forward.

Question 10

Patent Ductus Arteriosus (PDA)

Answer 10

Has a “machinery-like” quality.

Question 11

Cervical Venous Hum

Answer 11

A normal finding in children, loudest during diastole, and can be modulated by changing posture or pressure on the jugular vein.

Question 12

Mid-Systolic Clicks and Significance:

Answer 12

Indicate mitral valve prolapse, often accompanied by mitral regurgitation murmurs

Question 13

Pericardial Friction Rub:

Answer 13

Caused by pericardial membrane inflammation, and has three components—heard best along the lower left sternal border.

Question 14

Ventricular Septal Defect (VSD

Answer 14

Causes a holosystolic murmur, usually loudest at the left lower sternal border.

Question 15

Atrial Septal Defect (ASD

Answer 15

A soft mid-systolic murmur with a widely split S2 unaffected by respiration.

Question 16

Which heart sound is commonly heard in children and young adults and is considered normal?
- A) S1
- B) S2
- C) S3
- D) S4

Answer 16

Answer: C) S 3**

Question 17

A 10-year-old male presents for a routine examination. You hear a “vibratory” or “musical” murmur loudest in the apicosternal region. This is likely:
- A) Still’s murmur
- B) Mitral regurgitation
- C) Aortic stenosis
- D) Patent ductus arteriosus

Answer 17

*Answer: A) Still’s murmur**

Question 18

The mid-systolic click is often associated with which condition?
- A) Atrial septal defect
- B) Mitral valve prolapse
- C) Ventricular septal defect
- D) Aortic regurgitation

Answer 18

*Answer: B) Mitral valve prolapse

Question 19

Which murmur has a “machinery-like” quality and is continuous throughout systole and diastole?
- A) Patent ductus arteriosus
- B) Aortic stenosis
- C) Pulmonic stenosis
- D) Tricuspid regurgitation

Answer 19

*Answer: A) Patent ductus arteriosus**

Question 20

The S4 heart sound is also known as:
- A) An atrial gallop
- B) A ventricular gallop
- C) An innocent murmur
- D) A systolic ejection sound

Answer 20

Answer: A) An atrial gallop

Question 21

Which of the following murmurs is typically described as high-pitched and blowing, and best heard at the apex of the heart?
- A) Tricuspid regurgitation
- B) Mitral regurgitation
- C) Pulmonary stenosis
- D) Aortic stenosis

Answer 21

*Answer: B) Mitral regurgitation**

Question 22

What is a characteristic of the murmur associated with aortic stenosis?
- A) Holosystolic, best at the apex
- B) Crescendo-decrescendo, best in the aortic area
- C) Early diastolic, soft and blowing
- D) Continuous, machinery-like

Answer 22

*Answer: B) Crescendo-decrescendo, best in the aortic area**

Question 23

Which heart sound or phenomenon is a pathologic finding frequently associated with heart failure in children?
- A) S3
- B) S4
- C) Summation gallop
- D) Continous murmur

Answer 23

*Answer: C) Summation gallop**

Question 24

You hear a high-pitched, early diastolic murmur best at the lower left sternal border. Which condition might this indicate?
- A) Aortic stenosis
- B) Aortic regurgitation
- C) Mitral stenosis
- D) Tricuspid regurgitation

Answer 24

Answer: B) Aortic regurgitation

Question 25

Which maneuver can help decrease the intensity of a cervical venous hum?
- A) Sitting the child upright
- B) Having the child lie down
- C) Rotating the child’s head towards the side being examined
- D) Deep expiration against a closed glottis

Answer 25

Answer: B) Having the child lie down