Heart murmurs

Question 1

inspiration

Answer 1

increase intensity of right heart sound

Question 2

expiration

Answer 2

increase intensity of left heart sound

Question 3

hand grip

increase systemic vascular resistance

Answer 3

increase intensity of MR, AR, VSD, MVP murmurs

decrease intensity of AS, hypertrophic cardiomyopathy murmurs

Question 4

valsalva

decrease venous return

Answer 4

increase intensity of MVP, hypertrophic cardiomyopathy

decrease intensity of most murmurs

Question 5

rapid squatting
(increase venous return, increase preload, increase afterload with prolonged squatting)

Answer 5

decrease intensity of MVP, hypertrophic cardiomyopathy

Question 6

systolic heart sounds

Answer 6

aortic stenosis
pulmonic stenosis
mitral regurgitation
tricuspid regurgitation
VSD

Question 7

Diastolic heart sounds

Answer 7

aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis

Question 8

holosystolic, high-pitched “blowing murmur”

Answer 8

Mitral/ trisucpid regurgitation

Question 9

mitral regurgitation is loudest at the ______

Answer 9

apex

Question 10

MR is enhanced by ____ , _____ and ______

Answer 10

squatting
hand grip
expiration

often due to ischemic heart disease, mitral valve prolapse, LV dilation, infective endocarditis, rheumatic fever

Question 11

TR is loudest at the _____

Answer 11

tricuspid area and radiates to right sternal border

Question 12

TR is enhanced by ______

Answer 12

inspiration

can be caused by RV dilation, rheumatic fever, infective endocarditis

Question 13

crescendo-decrescendo systolic ejection murmur following ejection click

Answer 13

Aortic stenosis

ejection click due to abrupt halting of valve leaflets… LV&raquo_space; aortic pressure during systole

Question 14

AS is best heart at _____

Answer 14

aortic area

often due to age-related calcific aortic stenosis or bicuspid aortic valve

Question 15

pulses weak with a delayed peak

Answer 15

pulsus parvus et tardus

• seen in AS

Question 16

holosystolic, harsh-sounding murmur

Answer 16

VSD

Question 17

VSD is best heard at ____

-murmur accentuated by _____

Answer 17

tricuspid area

accentuated by hand grip maneuver (increases systemic vascular resistance)

Question 18

late systolic crescendo murmur with mid systolic click

Answer 18

MVP

-due to sudden tensing of the chord tendinae

Question 19

MVP is best heard at _____

-MVP is enhanced by _____ or ____

Answer 19

over apex
enhanced by standing or valsalva (decrease venous return)

can predispose to infective endocarditis
can be caused by myxomatous degeneration, rheumatic fever, or chord tendinae

Question 20

MVP is loudest at which heart sound?

Answer 20

S2

Question 21

immediate high pitched “blowing” diastolic decrescendo murmur

Answer 21

AR

often due to aortic root dilation, bicuspid aortic valve, endocarditis, or rheumatic fever

Question 22

wide pulse pressure when chronic

can present with bounding pulses and head bobbing

Answer 22

AR

Question 23

AR is best heart at _____
increase murmur via ____
decrease murmur via _____

Answer 23

left sternal border

increase: hand grip
decrease: vasodilators

Question 24

follows an opening snap

delayed rumbling late diastolic murmur

Answer 24

MS

LA» LV pressure during diastole

Question 25

MS is heard best at _____

enhanced by ___ (vague answer)

Answer 25

mitral area
enhanced by increased LA return (ex: expiration)

often secondary to rheumatic fever

Question 26

continuous machine-like murmur

Answer 26

PDA

often due to congenital rubella or prematurity

Question 27

PDA is best heard at which heart sound?

Answer 27

S2

Question 28

PDA is best heard at which area?

Answer 28

left infraclavicular area