Heart murmurs Flashcards
Systolic Murmur def
occurs during muscle contractions.
Divided into Ejections murmurs and Regurgitation murmurs
High pitched,
Crescendo- Decrescendo (“diamond shaped”),
Midsystolic murmor located at AORTIC LOSTENING POST radiating toward neck.
Aortic Stenosis
midsystolic, high-pitched, crescendo-decrescendo murmur heard best at the pulmonic listening post and radiating slightly toward the neck
increased intensity during inspiration
(does not radiate as widely)
Pulmonic Stenosis
Which of these could be an opening snap that becomes louder with inspiration?
A Tricuspid stenosis
B Aortic stenosis
C Pulmonary stenosis
D Mitral Stenosis
Tricuspid Stenosis
“opening snap” sounds. If a heart sound gets louder on inhalation, this is a clue that the sound is coming from the right side of the heart.
When you place your stethoscope on your patient you hear an early to mid systolic murmur in the pulmonic area with a fixed wide split S2 sound. What is the most likely diagnosis?
A Atrial septal defect
B Pulmonary valve regurgitation
C Ventricular septal defect
D Pulmonary stenosis
Atrial Septal Defect
The S2 is fixed-split in a person with an ASD. Mid systolic murmur in the pulmonic area with a fixed wide split S2 sound
Holosystolic Murmurs
name them bitch
AV valve regurgitation
Ventricular septal Defects (VSD)
Mitral regurgitation
Tricuspid regurgitation
Mitral valve prolapse
Which murmur is often described as a late systolic crescendo with a mid-systolic click?
A Aortic insufficiency B Aortic regurgitation C Aortic stenosis D Mitral valve stenosis E Mitral valve prolapse
Mitral valve prolapse
late systolic crescendo with a Mid-systolic click; created by the sudden tightening of the chordae tendineae in the left ventricle.
This is a harsh holosystolic murmur that is found at the apex. The murmur has a medium to high pitch sound. The sound of the murmur does not get louder with inspiration. The sound can radiate to the left axilla and sometimes the left sternal boarder. What is the most likely murmur?
A Mitral valve regurgitation
B Tricuspid regurgitation
C Ventricular septal defect
D Aortic stenosis
Mitral Valve Regurgitation
high-pitched, “blowing” holosystolic murmur loudest at the apex and radiating to the axilla are great clues for Mitral valve regurgitation; does not increase with inspiration, which helps to distinguish it from the murmur of tricuspid regurgitation.
Which stenosis is heard at the second right intercostal space?
Aortic Stenosis
Where would you hear an ventricular septal defect when auscultating the heart?
(aortic, pulmonary, tricupsid, mitral area?)
Tricuspid Area
Where would you hear a mitral regurgitation?
Left side of the chest over the apex of the <3 at the mid clavicular line
A systolic sound here would indicate mitral regurgitation. A diastolic sound here would indicate mitral stenosis.
Where would you listen to hear pulmonic stenosis?
2nd intercostal space along the left sternal border
Which of these would be heard while auscultating the right side of the chest?
Aortic Regurgitation
Which one of these is NOT heard at the pulmonic area?
A Pulmonic regurgitation
B Pulmonic stenosis
C Flow mumur (e.g. atrial septal defect)
Pulmonic Regurgitation
What are known to give off the sound of an “opening snap”?
Mitral and tricuspid stenosis
- tricuspid gets louder with inhalation
Which of the following options may be known as an “ejection click”?
A Aortic or Pulmonic Stenosis B Mitral Valve Regurgitation C Mitral Valve Stenosis D Ventricular Septal Defects E Pulmonary Hypertension
Aortic or Pulmonic Stenosis
**pulmonic stenosis does not radiate as widely as that of aortic stenosis; increased intensity during inspiration
What is S1? Where should it be auscultated (apex or base)?
- Closure of the AV (tricuspid/mitral) valves
- Beginning of systole
- Right before ejection of blood from ventricle
- Auscultate at the APEX
What is S2? Where should it be auscultated (apex or base)?
- Closure of the pulmonary/aortic valves
- End of systole
- Auscultate at the BASE
What is S3? When does it occur? What does it indicate?
Ventricular gallop
- Follows S2
- Sign of impaired early filling
- –Volume overload
- –Decompensated Heart Failure
- Rarely heard in normal subjects
What is S4? When does it occur? What does it indicate?
Atrial gallop
- Precedes S1
- Sign of impaired late filling
- –Pressure overload
- –LVH
- –Aortic stenosis
- Rarely heard in young subjects (but possible?)
S3 follows __&results from ____________ (by a stiff non-compliant __
S3 followsS2& results fromresistance to EARLY LV FILLING(by a stiff non-compliantLV
S4 precedes __ & results from ________ “ ____”
S4 precedesS1&results fromLATE FILLING “atrial kick”
S3 is a sign of ___________ with ______ whereas S4 is a sign of _________ often detected in ___ or ________
S3 is a sign ofdecompensated heart failurewithVOLUME overloadwhereas S4 is a sign ofPRESSURE overloadoften detected inLVHoraortic stenosis.
What is the driver for the physiologic splitting of S2?
Delay in P2 mostly due to longer RV emptying!
- Pulmonic delay (and slightly earlier aortic closure sound— rarely perceptible)
What characterizes an atrial septal defect?
Wide and fixed splitting of S2
Wide and fixed splitting of the 2nd heart sound is characteristic of? A. Ventricular septal defect B. Atrial septal defect C. Pulmonic stenosis D. Bicuspid aortic valve E. Mitral valve prolapse
Atrial Septal Defect
Physiologic splitting of the 2nd heart sound is due to? A. Inspiratory delay in LV emptying B. Expiratory delay in LV emptying C. Inspiratory delay in RV emptying D. Expiratory delay in RV emtpying
Inspiratory delay in RV emptying
