Heart murmurs

Question 1

A high-pitched holosystolic murmur is heard best at the apex and radiates to the axilla. The murmur is enhanced by squatting and doing the hand grip maneuver. What is the murmur?

Answer 1

Mitral regurgitation

Question 2

A high-pitched holosystolic murmur is heard best at the Left T5/sternal border and radiates to the right sternal border. The murmur is enhanced with inspiration. What is the murmur?

Answer 2

Tricuspid regurgitation

Question 3

A harsh-sounding holosystolic murmur is heard best at the left T5/sternal border. The murmur is enhanced with hand gripping. What is the murmur?

Answer 3

VSD

Question 4

A patient has weak pulses and episodes of syncope, angina, and DoE. What is expected to be heard on auscultation?

Answer 4

Aortic stenosis presents as a crescendo-decrescendo systolic ejection murmur heard best at the right T2/sternal border and radiates to the carotids

Question 5

A late systolic crescendo murmur with a mid systolic click is heard best over the apex. The murmur presents earlier by standing or by doing the valsalva maneuver. What is the murmur?

Answer 5

Mitral Valve Prolapse

Question 6

A patient presents with a bounding pulse and head bobbing. What is expected from auscultation?

Answer 6

Aortic regurgitation presents with a high-pitched “blowing” early diastolic decrescendo murmur that is enhanced by hand gripping

Question 7

A delayed rumbling diastolic murmur is heard after an opening snap at the apex. The murmur is enhanced with expiration. What is the murmur?

Answer 7

Mitral stenosis

Decreased interval between S2 and opening snap = increased severity

Question 8

What maternal congenital disease can cause a child to have a continuous machine-like murmur?

Answer 8

Congenital rubella can cause a PDA

Question 9

Why does squatting or hand gripping change the intensity of some murmurs?

Answer 9

Squatting and hand gripping increases TPR…increases afterload

Question 10

Why does inspiration enhance some murmurs?

Answer 10

Inspiration increases right atrial return

Question 11

Why does standing or doing the valsalva maneuver enhance some murmurs?

Answer 11

Valsalva/standing decreases venous return

Question 12

What three murmurs present as holosystolic?

Answer 12

Mitral Regurgitation
Tricuspid Regurgitation
VSD

Question 13

Tricuspid regurgitation and VSD are both heard at the lower left sternal margin. How can these two murmurs be distinguished?

Answer 13

Hand gripping/squatting enhances VSD

Inspiration enhances tri regurg