Heart Murmurs

Question 1

Mitral/Tricuspid Regurgitation Description

Answer 1

Holosystolic, High-Pitched Blowing Murmur

Question 2

Where is MR heard and radiated to?

Answer 2

• Loudest at apex.

- Radiates toward axilla.

Question 3

What is MR enhanced by?

Answer 3

• Enhanced by maneuvers that increase TPR (squatting, hand grip) or LA return (expiration).

Question 4

Causes of MR

Answer 4

Ischemic Heart Disease, Mitral Valve Prolapse Rheumatic Fever, Infective Endocarditis, or LV Dilation (DCM)

Question 5

Where is TR heard and radiated to?

Answer 5

Loudest at tricuspid area and radiates to right sternal border

Question 6

TR Enhanced by

Answer 6

Maneuvers that increase RA return (inspiration)

Question 7

Causes of TR

Answer 7

RV Dilation (DCM), Rheumatic Fever, and Infective Endocarditis

Question 8

Description of Aortic Stenosis

Answer 8

• Crescendo-Decrescendo Systolic Ejection Murmur Following Ejection click due to abrupt halting of valve leaflets.

Question 9

Aortic Stenosis radiates to

Answer 9

Carotids/heart base

Question 10

Aortic Stenosis can lead to

Answer 10

SAD

- Syncope, Angina, and Dyspnea on exertion

Question 11

Aortic Stenosis often due to

Answer 11

Age-related (>70 yrs) calcific aortic stenosis or bicuspid aortic valve (congenital and shows up ages 50-60 yrs)

Question 12

Findings of Aortic Stenosis

Answer 12

LV Hypertrophy (common) and LV pressure greater than Aortic Pressure during Systole

Question 13

Ejection Click of Aortic Stenosis occurs

Answer 13

Just after S1

Question 14

Description of Ventricular Septal Defect (VSD)

Answer 14

Holosystolic, Harsh-Sounding Murmur

Question 15

VSD Found at and enhanced by

Answer 15

• Tricuspid area

- Enhanced by hand grip maneuver due to increased afterload

Question 16

Description of Mitral Valve Prolapse (MVP)

Answer 16

Late Systolic Crescendo murmur with midsystolic click due to sudden tensing of the chordae tendineae.

Question 17

MVP Best Heard Where and When

Answer 17

• Heard over apex and loudest right before and at S2.

Question 18

MVP caused by

Answer 18

Myxomatous degeneration, rheumatic fever, or chordae rupture.

Question 19

MVP Enhanced by

Answer 19

Maneuvers that decrease venous return (standing or valsalva)

Question 20

MVP Findings and Typical Patients

Answer 20

• Fibrosa layer (strength of leaflet) is thinned with myxomatous expansion of the spongiosa.
• Young Women

Question 21

Description of Aortic Regurgitation (AR)

Answer 21

Immediate high-pitched blowing diastolic decrescendo murmur heard right after S2.

Question 22

Pts with AR present with

Answer 22

Wide pulse pressure when chronic, bounding pulses and head bobbing (due to hyperdynamic circulation).

Question 23

AR Often due to

Answer 23

Aortic Root Dilation, bicuspid aortic valve, endocarditis, or rheumatic fever.

Question 24

AR enhanced and decreased by

Answer 24

• Enhanced during hand grip and decreased intensity with vasodilators

Question 25

Description of Mitral Stenosis

Answer 25

- Follows opening snap due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips.

Question 26

MS sounds like

Answer 26

Rumbling late diastolic murmur

Question 27

Chronic MS can result in

Answer 27

LA dilation due to LA pressure being greater than LV pressure during diastole

Question 28

MS enhanced by

Answer 28

Maneuvers that increase LA return (expiration, Pulmonary congestion/HTN, Atrial Fibrillation

Question 29

MS Often occurs secondary to

Answer 29

Rheumatic Fever

Question 30

Description of PDA

Answer 30

Continuous machine-like murmur that is loudest at S2 and best heard at the left infraclavicular area.

Question 31

PDA Often due to

Answer 31

Congenital Rubella or Prematurity