heart murmurs

Question 1

causes of mitral stenosis

Answer 1

rheumatic heart disease (scarred leaflets fuse cause rapid opening snap)

Question 2

complication of chronic mitral stenosis

Answer 2

LA dilation

Question 3

mitral stenosis is enhanced by

Answer 3

expiration (↑LA filling)

vs S2 splitting (worsened by inspiration)

Question 4

where do you here mitral stenosis

Answer 4

L. 5th ICS or left lateral decubitus

Question 5

sound of mitral stenosis

Answer 5

opening snap after S2 (isovolumetric relaxation (all valves closed) → fused, scarred leaflets rapidly open when mitral pressure is greater)

Question 6

cause of aortic regurgitation

Answer 6

aortic root dilation: 3° syphilis (thoracic aorta + aortic root) or Marfan syndrome
bicuspid aortic valve (usually aortic stenosis though)
rheumatic fever

Question 7

sound of aortic regurgitation

Answer 7

high-pitched “blowing” early diastolic decrescendo

Question 8

signs of aortic regurgitation

Answer 8

wide pulse pressure (120/40): low diastolic pressure

presents as: BOUNDING peripheral pulses “water hammer” pulse + head bobbing

Question 9

sound of PDA

Answer 9

continous machine-like murmur

loudest at S2

Question 10

cause of PDA

Answer 10

congenital rubella

prematurity

Question 11

valve affected most by rheumatic fever

Answer 11

mitral valve

Question 12

valve most affected by IVDU

Answer 12

tricuspid valve (tricuspid regurgitation due to infective endocarditis)

Question 13

causes of aortic stenosis

Answer 13

1) bicuspid aortic valve (can also cause aortic regurgitation): symptomatic >40 yo due to calcification on abnormal valve (can’t open as wide as 3 leaflet)
2) senile (degenerative) calcification: symptomatic >60 yo (normal valve)
3) chronic rheumatic heart disease
4) unicuspid aortic valve
5) 3° syphilis - aortic root + valve

Question 14

sound of aortic stenosis

Answer 14

ejection click (scarred leaflets open after isovolumetric contraction) after S1 then crescendo-decrescendo systolic murmur 
*radiates to carotids*

Question 15

signs of aortic stenosis

Answer 15

less blood to periphery per contraction → WEAK, delayed peripheral pulses
SAD: Syncope or Angina or Dyspnea (need valve replaced!)

Question 16

sound of mitral regurgitation

Answer 16

holosystolic

radiates to axilla

Question 17

cause of mitral regurgitation

Answer 17

1) rheumatic heart disease
2) infective endocarditis
3) ischemic heart disease
4) LV dilation
5) mitral valve prolapse

Question 18

sound of mitral valve prolapse

Answer 18

midsystolic click (contraction of ventricles causes pressure against mitral valve → extra floppy mitral valve balloons out into LA → chordae tendinae suddenly tense) followed by crescendo murmur

Question 19

complication of mitral valve prolapse

Answer 19

occurs when cocurrent mitral regurgitation (but not a required feature of MVP)

Question 20

sound of tricuspid regurgitation

Answer 20

holosytolic murmur

radiates to right sternal border

Question 21

causes of tricuspid regurgitation

Answer 21

rheumatic fever
infective endocarditis (IVDU)

Question 22

sound of VSD

Answer 22

holosytolic in newborn!

vs. tricuspid regurgitation

Question 23

sound of tricuspid stenosis

Answer 23

late diastolic decrescendo murmur heard best along left lower sternal border

Question 24

sound of pulmonic stenosis

Answer 24

crescendo-decrescendo systolic murmur

Question 25

Only affects aortic valve

Answer 25

3 syphillis: stenosis or regurg

Question 26

Infective endocarditis can cause

Answer 26

Mitral regurg or tricuspid regurg (ivdu)

Question 27

Rheumatic fever affects

Answer 27

Mitral ( regurg or stenosis) mostly but also aortic ( regurg or stenosis) or tricuspid