heart murmurs

Question 1

what to look for on inspection

Answer 1

look at the patient overall. signs of diminished cardiac output, HF, atherosclerotic disease. look for PMI

Question 2

aortic valve space?

Answer 2

second right intercostal space at the right sternal border.

Question 3

pulmonic valve space

Answer 3

second left intercostal space at the left sternal border

Question 4

second pulmonic valve space

Answer 4

third left intercostal space at the left sternal border.

Question 5

tricuspid valve space

Answer 5

fourth left intercostal at left sternal border.

Question 6

mitral valve space

Answer 6

at the apex. the fifth intercostal space at the midclavicular line

Question 7

how should we listen to the heart sounds?

Answer 7

with the patient in 2 different positions

Question 8

what is the best position for listening to high-pitched sounds

Answer 8

sitting up and leaning slightly forward.

Question 9

what is the best position for listening to low-pitched sounds?

Answer 9

left lateral decubitus position

Question 10

what is the lub or S1?

Answer 10

this represents closure of the mitral and tricuspid valves or the beginning of systole. corresponds to the upstroke of the carotid pulse.

Question 11

where is S1 heard best?

Answer 11

at the apex.

Question 12

what is the dub or the S2

Answer 12

represents the closure of the aortic and pulmonic valves and signals the end of systole.

Question 13

where is S2 heard the loudest?

Answer 13

heard loudest at the base of the heart.

Question 14

S3

Answer 14

kentucky gallop. represents the passive diastolic filling of the ventricle. this is heard immediately after S2 and when the filling pressure is elevated. it is a low pitched sound heard best at the apex with the bell.

Question 15

what position is best for hearing the S3?

Answer 15

left lateral decubitus position

Question 16

when is the S3 normal?

Answer 16

in children and young adults

Question 17

S4

Answer 17

tennessee gallop. represents active atrial filling of the ventricle -the second phase of ventricular filling. occurs immediately before S1. this is louder than S3. best heard at the apex.

Question 18

what position is best for S4?

Answer 18

lateral decubitus or supine. still heard the best with the bell at the apex.

Question 19

when is the S4 common?

Answer 19

left ventricular hypertrophy and myocardial ischemia.

Question 20

murmur?

Answer 20

caused by distortion of blood flow through the heart.

Question 21

what is the primary cause of a murmur?

Answer 21

malfunction of a valve disrupting blood flow

Question 22

how do we describe a murmur

Answer 22

timing (systolic/diastolic) pitch, pattern, location, radiation

Question 23

grade 1 murmur

Answer 23

barely audible

Question 24

grade II murmur

Answer 24

quiet, intensity similar to S1/S2

Question 25

grade III murmur

Answer 25

moderate.

Question 26

grade IV murmur

Answer 26

loud with a thrill

Question 27

grade V

Answer 27

very loud and easily palpable thrill

Question 28

grade VI murmur

Answer 28

audible with stethoscope off of chest

Question 29

examples of systolic murmur

Answer 29

mitral regurg and aortic stenosis

Question 30

mitral regurgitation when?

Answer 30

can be early systolic, late systolic, holosystolic

Question 31

mitral regurgitation heard best where?

Answer 31

over the apex

Question 32

where does mitral regurgitation radiate?

Answer 32

to the back and the clavicle.

Question 33

what changes the intensity of the mitral regurgitation

Answer 33

isometric exercise will increase

Question 34

aortic stenosis when?

Answer 34

considered a mid-systolic murmur

Question 35

what is the character of aortic stenosis

Answer 35

crescendo-decrescendo

Question 36

where is aortic stenosis heard best?

Answer 36

in the aortic region

Question 37

where does aortic stenosis radiate?

Answer 37

to the neck.

Question 38

how do we change the intensity of aortic stenosis and how does it change?

Answer 38

isometric exercise decreases. squatting increases

Question 39

what happens to S2 when A2 becomes softer?

Answer 39

it decreases in intensity

Question 40

examples of diastolic murmurs

Answer 40

aortic regurgitation or mitral stenosis

Question 41

aortic regurgitation heard best where?

Answer 41

in the 3rd left intercostal space.

Question 42

where does aortic regurgitation radiate

Answer 42

along the left sternal border

Question 43

what is the nature of aortic regurgitation

Answer 43

early diastolic and decrescendo in nature

Question 44

how do we change the intensity of aortic regurgitation and how does it change?

Answer 44

increases with isometric exercise and squatting

Question 45

where is mitral stenosis heard best

Answer 45

over the apex

Question 46

what is the character of mitral stenosis

Answer 46

low pitched rumbling so remember the left lateral position

Question 47

when for the mitral stenosis

Answer 47

mid-diastolic murmur that extends in duration as stenosis worsens

Question 48

how do we change the intensity and how does it sound?

Answer 48

isometric exercise will increase the murmurs intensity