Heart Murmurs

Question 1

Crescendo-decrescendo systolic ejection murmur.

Answer 1

Aortic Stenosis

Question 2

LV&raquo_space; aortic pressure during systole. Loudest at heart base; radiates to carotids.

Answer 2

Aortic Stenosis

Question 3

“Pulsus parvus et tardus”—pulses are weak with a delayed peak

Answer 3

Aortic Stenosis

Question 4

Can lead to Syncope, Angina, and Dyspnea on exertion (SAD)

Answer 4

Aortic Stenosis

Question 5

Often due to age-related calcification or early-onset calcification of bicuspid aortic valve.

Answer 5

Aortic Stenosis

Question 6

Holosystolic, high-pitched “blowing murmur.”

Answer 6

mitral or tricuspid regurg

Question 7

loudest at apex and radiates toward axilla.

Answer 7

Mitral Regurg

Question 8

often due to ischemic heart disease (post-MI), MVP, LV dilatation

Answer 8

Mitral Regurg

Question 9

loudest at tricuspid area and radiates to right sternal border.

Answer 9

Tricuspid Regurg

Question 10

commonly caused by RV dilatation.

Answer 10

Tricuspid Regurg

Question 11

Rheumatic fever and infective endocarditis can cause (two murmurs) what are they?

Answer 11

Mitral or Tricuspid Regurg

Question 12

Late systolic crescendo murmur with midsystolic click (MC; due to sudden tensing of chordae tendineae

Answer 12

Mitral valve prolapse (MVP)

Question 13

Most frequent valvular lesion

Answer 13

Mitral valve prolapse (MVP)

Question 14

Best heard over apex. Loudest just before S2. Usually benign

Answer 14

Mitral valve prolapse (MVP)

Question 15

Can predispose to infective endocarditis

Answer 15

Mitral valve prolapse (MVP)

Question 16

Can be caused by myxomatous degeneration (1° or 2° to connective tissue disease such as Marfan or Ehlers-Danlos syndrome), rheumatic fever, chordae rupture

Answer 16

Mitral valve prolapse (MVP)

Question 17

Holosystolic, harsh-sounding murmur. Loudest at tricuspid area.

Answer 17

VSD

Question 18

High-pitched “blowing” early diastolic decrescendo murmur.

Answer 18

Aortic Regurgitation

Question 19

Long diastolic murmur and signs of hyperdynamic pulse when severe and chronic causing head bobbing

Answer 19

Aortic Regurgitation

Question 20

Often due to aortic root

dilation, bicuspid aortic valve, endocarditis, rheumatic fever.

Answer 20

Aortic Regurgitation

Question 21

Progresses to left HF.

Answer 21

Aortic Regurgitation

Question 22

Follows opening snap (OS; due to abrupt halt in leaflet motion in diastole, after
rapid opening due to fusion at leaflet tips).

Answer 22

Mitral Stenosis

Question 23

Delayed rumbling late diastolic murmur ( decreased interval between S2 and OS correlates with increased severity).

Answer 23

Mitral Stenosis

Question 24

LA&raquo_space; LV pressure during diastole.

Answer 24

Mitral Stenosis

Question 25

Often occurs 2° to rheumatic fever

Answer 25

Mitral Stenosis

Question 26

Continuous machine-like murmur loudest at S2

Answer 26

PDA

Question 27

Often due to congenital rubella or prematurity. Best heard at left infraclavicular area.

Answer 27

PDA

Question 28

BEDSIDE MANEUVER:

Inspiration (increased venous return to right atrium)

Answer 28

increased intensity of right heart sounds

Question 29

BEDSIDE MANEUVER:

Hand grip (increased afterload)

Answer 29

increased intensity of MR, AR, VSD murmurs

decreased in hypertrophic cardiomyopathy murmurs

MVP: later onset of click/murmur

Question 30

BEDSIDE MANEUVER:

Valsalva (phase II), standing up (decreased preload)

Answer 30

decreased intensity of most murmurs (including AS)
BUT increased intensity of hypertrophic cardiomyopathy murmur

MVP: earlier onset of click/murmur

Question 31

BEDSIDE MANEUVER:

Rapid squatting (increase venous return, increase preload)

Answer 31

decreased intensity of hypertrophic cardiomyopathy murmur and increased intensity of AS murmur

MVP: later onset of click/murmur

Question 32

Wide fixed splitting of the second heart sound. Can lead to chronic pulmonary hypertension

Answer 32

ASD: chronic pulm HTN will lead to L–> R shunting and Eisenmenger syndrome