Heart murmurs

Question 1

Mitral regurgitation

Answer 1

Systolic:

Holosystolic, high-pitched blowing murmur

Loudest at apex and radiates towards axilla
Enhanced by maneuvers that increase TPR (squatting, hand grip)
Often due to ischemic heart disease, MVP, LV dilation

Question 2

Tricuspid regurgitation

Answer 2

Systolic:

Holosystolic, high-pitched blowing murmur
Loudest at tricuspid are and radiates to right sternal border
Enhanced by maneuvers hat increase RA return (inspiration)
Caused by RV dilation

Question 3

Aortic stenosis

Answer 3

Systolic

Crescendo-decrescendo systolic ejection murmur following ejection click
Radiates to carotids/heart base
Pulses are weak with delayed peak
Syncope, angina and dyspnea
Due to age related calcifications or bicuspid aortic valve

Question 4

VSD

Answer 4

Systolic

Holosystolic, harsh-sounding murmur
Loudest at tricuspid area
Accentuated by hand grip

Question 5

Mitral valve prolapse

Answer 5

Systolic

Late systolic crescendo murmur with mid systolic click
Best heard over apex
Loudest at S2
Predispose to infective endocarditis
Caused by myxomatosis degeneration, rheumatic fever, chorale rupture
Enhanced by maneuvers that decrease venous return

Question 6

Aortic regurgitation

Answer 6

Diastolic

Immediate high-pitched blowing diastolic decrescendo murmur
Wide pulse pressure when chronic
Bounding pulses and head bobbing
Due to root dilation, bicuspid aortic valve, endocarditis or rheumatic fever
Increase murmur during hand grip
Vasodilator decrease intensity of murmur

Question 7

Mitral stenosis

Answer 7

Diastolic

Follow opening snap, delayed rumbling late diastolic murmur
Often secondary to rheumatic fever
Chronic MS can result in LA dilation
Enhanced by manuevers that increase LA return (expiration)

Question 8

PDA

Answer 8

Continuous

Continuous machine-like murmur, loudest at S2
Often due to congenital rubella or prematurity
Best heard at infraclavicular area