heart murmurs

Question 1

what are the diastolic heart murmurs?

Answer 1

mitral or tricuspid stenosis - narrowed valves cause turbulant flow from atrium to ventricals during ventricular filling - makes murmur

aortic or pulmonic regurgitation

Question 2

what are the normal positions of the APTM valves during diastole?

Answer 2

T/M should be open
A/P should be closed

therefore if T/M stenosis (think about as difficulty with opening due to stiff/narrow valve) turbulant flow results in murmur during ventricular filling

similarly if there is regurgitation of the A/P valves (when they are supposed to be shut) turbulant flow is created by blood leaking back into the ventricals during filling (blood comes from both directions)

Question 3

what are the normal positions of the APTM valves during systole?

Answer 3

T/M should be closed - so regurgitant makes murmur

A/P should be open - so stenosis makes murmur

Question 4

what murmur is accentuated by hand-grip?

Answer 4

mitral regurgitation - handgrip increases SVR and afterload

Question 5

what does the valsalva manuver accomplish, how does this contrast with inspiration?

Answer 5

valsalva increases intrathoracic pressure - opposite of inspiration - reduces pre-load and afterload

Question 6

most murmors get quieter due to valsalva because less venous return and also less afterload. One murmur is increased by valsalva - which is it?

Answer 6

hypertrophic cardiomyopathy

Question 7

what causes an early diastolic murmur best heart on the left sternal boarder with a wide pulse pressure and bounding peripheral pulses?

Answer 7

aortic regurgitation

normal systolic pressure with low systemic diastolic due to regurg makes for bounding pulses or “water hammer pulse”

can also cause head-bobbing

Question 8

what causes aortic regurgitation?

Answer 8

aortic root dilation - e.g. from syphalus (can also cause aortic stenosis with “tree” barking or aorta) or marfans syndrojme

bicupid aortic valve
Rhumatic fever

Question 9

what heart murmur is heart best at the apex of the heart and is louder when laying in the left lateral decubitus position

Answer 9

mitral stenosis - diastolic murmor with short delay from S2 and opening click

mitral regurgitation - systolic murmor immediately after S1

left sided S3,S4

Question 10

how is mitral stenosis affected by breathing?

Answer 10

enhanced by expiration because more blood is returning to the left atrium

Question 11

how does a PDA present as a murmur?

Answer 11

machine-like holosystolic murmor

close with indomethacin

Question 12

when would aortic stenosis be heart in regard to the cardiac cycle?

Answer 12

systolic murmor that occurs immediately following isovolumetric contraction (slightly delayed ejection click) - shortly after S1

Question 13

what causes a cresciendo decresecndo systolic heart murmor best heard at the right sternal boarder with radiation to the corrotids and weak, delayed peripheral pulses?

Answer 13

aortic stenosis

narrowed stenotic valve blocks blood from getting into aorta, reducing force of each contraction felt in peripheral pulses

Question 14

pt has a systolic heart murmur with radiation to the corrotids and weak, delayed peripheral pulses. What other finding might be present?

Answer 14

syncope
angina
SOB/dyspnea

Question 15

what are the causes of aortic stenosis?

Answer 15

MC = bicuspid aortic valve (becomes problem >40)
senile calcification (>60)
chronic rhumatic heart disease

Question 16

what causes a holosystolic murmor that beings immediately following S1 and is best heart at the apex, with radiation to the left axilla?

Answer 16

mitral regugitation

Question 17

which systolic heart murmur is enhanced by laying in the left lateral decubitus position, squatting or with hand-grip?

Answer 17

mitral regugitation

Question 18

how does mitral valve prolapse present?

Answer 18

mid-systolic click

large valve leaflets take a long time to reach the furthest stretch point of the cordae tendinae as they close and billow back into the atrium during systole

Question 19

does tricupid regurgitation present?

Answer 19

same as mitral regurge (holosystolic) but heard at the left lower sternal boarder rather than mid clavifular line/apex

Question 20

does tricupid regurge get loader with inspiration or expiration?

Answer 20

inspiration because increased venous return gives right ventrical more preload to push back through tricuspid valve

Question 21

how does a ventricular septal defect present?

Answer 21

holosystolic murmur that presents essentially identical to tricuspid regurgitation (holosystolic murmur best heard at left lower sternal boarder) and gets loader with inspiration

MUST USE CLINICAL SCENARIO TO DIFFERNTIATE
if newborn ==> VSD
if IV drug user ==> tricuspid regugitation

Question 22

which heart murmur is assocaited with weak pulses?

Answer 22

aortic stenosis (pulses parvus et tardus) weak and delayed

Question 23

what murmor is associated with a cresiendo decreasendo systolic murmur best heard at the 2nd right intercostal space?

Answer 23

aortic stenosis

Question 24

what causes an early diastolic decresciendo murmur best heard along upper left of sternum?

Answer 24

pulmonic regurg

Question 25

what causes a late diastolic decresiendo murmur best heard along lower left side of sternum?

Answer 25

tricuspid stenosis

Question 26

pansystolic murmur heard best at the apex and often radiates to the left axilla?

Answer 26

mitral regurg

Question 27

late systolic murmur usually preceded by a mid-systolic click

Answer 27

mitral valve prolapse

Question 28

crescendo-decresendo systolic mumur best heard in the 2nd-3rd left intercostal space at the left sternal boarder?

Answer 28

pulmonic stenosis

Question 29

pansystolic murmur best heard along left lower sternal boarder that radiates to the right lower stenal boarder

Answer 29

tricuspid regurg or VSD

Question 30

rubling late diastolic murmur with opening snap heard loudest at the apex

Answer 30

mitral stenosis?

Question 31

continuous machine like murmor (holosystolic)

Answer 31

PDA

Question 32

high pitched diastolic murmur asscated with widened pulse pressure?

Answer 32

aortic regurgitation

Question 33

crescendo-decresendo murmor heard best between the apex and left sternal bboarder radiating to the suprasternal notch. Murmur becomes louder when standing.

Answer 33

hypertrphchic cardiomyopathy

louder with decreased preload