Heart murmurs

Question 1

Holosystolic, high-pitched “blowing murmur”
Loudest at apex; radiates–>axilla.
Enhanced by maneuvers that increase TPR

Answer 1

Mitral regurg

Question 2

Holosystolic, high-pitched “blowing murmur”
Loudest at LSB at 5th IC space; radiates–>RSB
Enhanced by maneuvers that increase RA return

Answer 2

Tricuspid regurg

Question 3

Causes of MR (5)

Answer 3

IHD, MVP, LV dilation, ARF, IE

Question 4

Causes of TR (3)

Answer 4

RV dilation, ARF, IE

Question 5

Crescendo-decrescendo systolic ejection murmur
Loudest at heart base; radiates–> carotids
Pulses are weak w/ delayed pulse

Answer 5

Aortic stenosis

Question 6

Holosystolic, harsh-sounding murmur
Loudest @ LSB at 5th IC space
Accentuated w/ hand grip

Answer 6

VSD

Question 7

Late systolic crescendo murmur w/ midsystolic click. Heard best over apex; loudest just before S2. Occurs earlier w/ maneuvers that decrease venous return; later with those that increase SVR or venous return.

Answer 7

MVP

Question 8

High-pitched “blowing” early diastolic decrescendo murmur.
Wide pulse P
Increased intensity w/ hand grip; decreased w/ vasodilators.

Answer 8

Aortic regurg

Question 9

Delayed rumbling late diastolic murmur following the opening snap.
Enhanced w/ maneuvers that increase LA return
Smaller interval btwn S2 and OS= greater severity

Answer 9

Mitral stenosis

Question 10

Continuous machine-like murmur

Loudest at S2; best heard at left infraclavicular area.

Answer 10

PDA

Question 11

Cause of split S2 with inspiration

Answer 11

physiologic

Question 12

Cause of widened splitting with expiration and inspiration

Answer 12

R bundle branch block

pulmonary stenosis

Question 13

Cause of fixed splitting with inspiration and expiration

Answer 13

atrial septal defect

Question 14

Cause of paradoxical splitting

Answer 14

L bundle branch block

advanced aortic stenosis

Question 15

Cause of diastolic opening snap

Answer 15

mitral stenosis

Question 16

Where does the mitral regurg murmur radiate?

Answer 16

Axilla

Question 17

What maneuvers enhance the MR murmur?

Answer 17

Those that increase TPR (squatting, hand grip)

Question 18

What’s the best (auscultory) indicator of severity of MR?

Answer 18

Presence of S3

Question 19

Where does the TR murmur radiate?

Answer 19

RSB

Question 20

What maneuvers enhance the TR murmur?

Answer 20

Those that increase RA return (inspiration)

Question 21

Where does the AS murmur radiate?

Answer 21

Carotids

Question 22

What maneuver increases VSD?

Answer 22

Hand grip, because it increases afterload

Question 23

What maneuvers make MVP occur earlier?

Answer 23

Those that decrease venous return (standing, Valsalva)

Question 24

Which murmur causes weak pulses with a delayed pulse?

Answer 24

Aortic stenosis

Question 25

Which murmur causes bounding pulses and head bobbing?

Answer 25

Aortic regurg

Question 26

What increases intensity of AR murmur?

Answer 26

Hand grip

Question 27

What decreases intensity of AR murmur?

Answer 27

Vasodilators (bc they decr afterload)

Question 28

What correlates with increased severity of MS murmur?

Answer 28

Decreased time btwn OS and S2

Question 29

What maneuvers increase MS intensity?

Answer 29

Those that increase LA return (eg: expiration)

Question 30

What's the primary determinant of forward:regurgitant flow ratio in MR?

Answer 30

LV afterload

Question 31

Systolic ejection murmur that increases in intensity with maneuvers that decrease venous return?

Answer 31

Hypertrophic cardiomyopathy

Question 32

How does inspiration affect the intensity of heart sounds?

Answer 32

Increases intensity of right-sided heart sounds

Question 33

What bedside maneuver increases systemic vascular resistance?

Answer 33

Hand grip

Question 34

Hand grip increases the intensity of which murmurs? (4)

Answer 34

MR AR MVP VSD

Question 35

Hand grip decreases the intensity of which murmurs? (2)

Answer 35

AS | HCM

Question 36

Which 2 bedside maneuvers decrease venous return?

Answer 36

Valsalva (phase 2) | Standing

Question 37

What's the main murmur that increases in intensity with decreased venous return?

Answer 37

HCM

Question 38

What bedside maneuver increases venous return and preload?

Answer 38

Rapid squatting

Question 39

How does afterload change with prolonged squatting?

Answer 39

Increases

Question 40

How does rapid squatting affect AS?

Answer 40

Increases intensity

Question 41

How does rapid squatting affect HCM?

Answer 41

Decreases intensity

Question 42

How does rapid squatting affect intensity of MVP?

Answer 42

Increases intensity

Question 43

How do hand grip, valsalva/standing, and rapid squatting affect timing of click and murmur in MVP?

Answer 43

Hand grip and rapid squatting: later onset | Valsalva/standing: earlier onset