Heart murmurs

Question 1

Systolic Murmur def

Answer 1

occurs during muscle contractions.

Divided into Ejections murmurs and Regurgitation murmurs

Question 2

High pitched,
Crescendo- Decrescendo (“diamond shaped”),
Midsystolic murmor located at AORTIC LOSTENING POST radiating toward neck.

Answer 2

Aortic Stenosis

Question 3

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)

Answer 3

Pulmonic Stenosis

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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

Question 6

Holosystolic Murmurs

name them bitch

Answer 6

AV valve regurgitation

Ventricular septal Defects (VSD)
Mitral regurgitation

Tricuspid regurgitation

Mitral valve prolapse

Question 7

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

Answer 7

Mitral valve prolapse

late systolic crescendo with a Mid-systolic click; created by the sudden tightening of the chordae tendineae in the left ventricle.

Question 8

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

Answer 8

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.

Question 9

Which stenosis is heard at the second right intercostal space?

Answer 9

Aortic Stenosis

Question 10

Where would you hear an ventricular septal defect when auscultating the heart?
(aortic, pulmonary, tricupsid, mitral area?)

Answer 10

Tricuspid Area

Question 11

Where would you hear a mitral regurgitation?

Answer 11

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.

Question 12

Where would you listen to hear pulmonic stenosis?

Answer 12

2nd intercostal space along the left sternal border

Question 13

Which of these would be heard while auscultating the right side of the chest?

Answer 13

Aortic Regurgitation

Question 14

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)

Answer 14

Pulmonic Regurgitation

Question 15

What are known to give off the sound of an “opening snap”?

Answer 15

Mitral and tricuspid stenosis

• tricuspid gets louder with inhalation

Question 16

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

Answer 16

Aortic or Pulmonic Stenosis

**pulmonic stenosis does not radiate as widely as that of aortic stenosis; increased intensity during inspiration

Question 17

What is S1? Where should it be auscultated (apex or base)?

Answer 17

• Closure of the AV (tricuspid/mitral) valves
• Beginning of systole
• Right before ejection of blood from ventricle
• Auscultate at the APEX

Question 18

What is S2? Where should it be auscultated (apex or base)?

Answer 18

• Closure of the pulmonary/aortic valves
• End of systole
• Auscultate at the BASE

Question 19

What is S3? When does it occur? What does it indicate?

Ventricular gallop

Answer 19

• Follows S2
• Sign of impaired early filling
• –Volume overload
• –Decompensated Heart Failure
• Rarely heard in normal subjects

Question 20

What is S4? When does it occur? What does it indicate?

Answer 20

Atrial gallop

• Precedes S1
• Sign of impaired late filling
• –Pressure overload
• –LVH
• –Aortic stenosis
• Rarely heard in young subjects (but possible?)

Question 21

S3 follows __&results from ____________ (by a stiff non-compliant __

Answer 21

S3 followsS2& results fromresistance to EARLY LV FILLING(by a stiff non-compliantLV

Question 22

S4 precedes __ & results from ________ “ ____”

Answer 22

S4 precedesS1&results fromLATE FILLING “atrial kick”

Question 23

S3 is a sign of ___________ with ______ whereas S4 is a sign of _________ often detected in ___ or ________

Answer 23

S3 is a sign ofdecompensated heart failurewithVOLUME overloadwhereas S4 is a sign ofPRESSURE overloadoften detected inLVHoraortic stenosis.

Question 24

What is the driver for the physiologic splitting of S2?

Answer 24

Delay in P2 mostly due to longer RV emptying!

• Pulmonic delay (and slightly earlier aortic closure sound— rarely perceptible)

Question 25

What characterizes an atrial septal defect?

Answer 25

Wide and fixed splitting of S2

Question 26

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

Answer 26

Atrial Septal Defect

Question 27

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

Answer 27

Inspiratory delay in RV emptying