Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology Secrets > HEART MURMURS AND SOUNDS > Flashcards

HEART MURMURS AND SOUNDS Flashcards

1
Q

What are the auscultatory areas of murmurs?

A

Aortic area, Pulmonic area, Mitral area, Tricuspid area

Auscultation typically starts in the aortic area and continues in a clockwise fashion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the Levine system for grading the intensity of murmurs?

A

Grades range from 1/6 (very soft) to 6/6 (extremely loud)

Increased intensity usually reflects increased flow turbulence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the causes of a systolic murmur?

A
  • Ejection: Increased forward flow over valves
  • Regurgitation: Backward flow from high to low pressure

Physiologic causes include anemia and exercise; pathologic causes include aortic stenosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are common causes of systolic murmurs?

A
  • Mitral regurgitation (MR)
  • Aortic stenosis (AS)
  • Tricuspid regurgitation
  • Hypertrophic cardiomyopathy (HCM)
  • Ventricular septal defect (VSD)

Functional murmurs are also included.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are common causes of diastolic murmurs?

A
  • Aortic regurgitation (AR)
  • Pulmonic regurgitation
  • Mitral stenosis (MS)
  • Tricuspid stenosis

Diastolic murmurs are usually pathologic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a functional murmur?

A

Benign findings caused by turbulent ejection into the great vessels

They have no clinical relevance other than being part of the differential diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common systolic ejection murmur of the elderly?

A

Murmur of aortic sclerosis

Affects 21% to 26% of persons aged 65 and 55% to 75% of octogenarians.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What factors suggest severe aortic stenosis?

A
  • Murmur intensity
  • Timing of the murmur

The louder and later peaking the murmur, the worse the condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can physical examination help differentiate functional from pathologic murmurs?

A
  • Golden rule 1: Judge murmurs by the company they keep
  • Golden rule 2: Diminished or absent S2 indicates pathology
  • Silver rules: All holosystolic, diastolic, and continuous murmurs are pathologic

Functional murmurs are typically short and soft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the grading for a 3/6 murmur?

A

Easily audible and relatively loud

Grading ranges from 1/6 (soft) to 6/6 (very loud).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fill in the blank: Aortic stenosis murmur becomes audible when the valvular area is reduced by at least _______.

A

50%

Significant hemodynamic compromise usually occurs at 60% to 70% reduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the types of systolic murmurs?

A
  • Early Systolic
  • Midsystolic
  • Late Systolic
  • Holosystolic

Each type has specific causes and characteristics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of continuous murmurs?

A
  • Patent ductus arteriosus (PDA)
  • Atriovenous (AV) fistula
  • Ruptured sinus of Valsalva aneurysm

Other causes include cervical venous hum and anomalous left coronary artery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the significance of a 60% to 70% reduction in the valvular area in aortic stenosis?

A

Significant hemodynamic compromise and symptoms usually do not occur until this reduction.

Early to mild aortic stenosis may be subtle at rest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What factors may suggest severe aortic stenosis?

A
  • Murmur intensity and timing (louder and later peaking indicates worse disease)
  • A single S2
  • Delayed upstroke and reduced amplitude of the carotid pulse (pulsus tardus et parvus)

The auscultatory findings in mild and severe AS change with disease severity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a thrill in the context of heart murmurs?

A

A palpable vibratory sensation typical of murmurs caused by very high-pressure gradients, present only in pathologic murmurs with intensity greater than 4/6.

Thrills indicate great turbulence and loudness.

17
Q

What is isometric handgrip and how does it affect murmurs?

A

A maneuver that increases peripheral vascular resistance; it intensifies mitral regurgitation (MR) and ventricular septal defect (VSD) murmurs while softening aortic stenosis (AS) murmurs.

A louder murmur with handgrip argues strongly in favor of MR.

18
Q

What is the Gallavardin phenomenon?

A
  • Atypical AS-like murmur (medium- to low-pitched, harsh, right parasternal)
  • A murmur that mimics MR (high-pitched, musical, best heard at the apex)

Reflects different transmission of AS frequencies.

19
Q

Where is the murmur of hypertrophic cardiomyopathy best heard?

A

Typically louder at the apex, but may also be louder at the left lower sternal border if septal hypertrophy obstructs both left and right ventricular outflow.

This can cause a differential diagnosis dilemma with mitral regurgitation murmur.

20
Q

What are the characteristics of a ventricular septal defect murmur?

A
  • Holosystolic, crescendo-decrescendo, crescendo, or decrescendo
  • Best heard along the left lower sternal border
  • Starts immediately after S1

The type of murmur may indicate the location of the defect in the septum.

21
Q

What defines a systolic regurgitant murmur?

A

Characterized by a pressure gradient causing retrograde blood flow across an abnormal opening, such as VSD or an incompetent valve.

Examples include incompetent mitral or tricuspid valves.

22
Q

What are the auscultatory characteristics of systolic regurgitant murmurs?

A
  • Start immediately after S1
  • May have a musical quality
  • Do not increase in intensity after a long diastole

This distinguishes them from systolic ejection murmurs.

23
Q

What are the characteristics of the mitral regurgitation murmur?

A
  • Loudest at the apex
  • Radiates to the left axilla
  • High-pitched, plateau, holosystolic extending into S2

The intensity and duration of the murmur correlate with the severity of regurgitation.

24
Q

What distinguishes the acute mitral regurgitation murmur from the chronic one?

A

Acute MR murmur is often early systolic and can be very short or absent, unlike chronic MR, which is typically holosystolic or late systolic.

80% of acute cases are associated with an S4.

25
Q

What are the characteristics of the mitral valve prolapse murmur?

A
  • Loudest at the apex
  • Mid- to late-systolic in onset
  • Often has a crescendo shape

Musical features are often present.

26
Q

How are diastolic murmurs classified?

A

Classified by timing:
* Early diastolic (reflecting aortic or pulmonic regurgitation)
* Mid- to late-diastolic (often with presystolic accentuation, reflecting mitral or tricuspid valve stenosis).

27
Q

What is the best strategy to detect the mitral stenosis murmur?

A

Listen over the apex with the patient in the left lateral decubitus position at the end of exhalation and after exercise.

Light pressure with the bell helps capture low frequencies.

28
Q

What are the typical auscultatory findings of aortic regurgitation?

A
  • Diastolic tapering murmur
  • May have up to three murmurs (one in systole, two in diastole)
  • Best heard over the Erb point or aortic area

Accompanying systolic murmurs may indicate severe regurgitation.

29
Q

What is a mammary souffle?

A

A systolic-diastolic murmur heard over the breasts in late pregnancy, caused by increased flow along the mammary arteries.

Typically disappears at the end of lactation.

30
Q

What factors determine whether a murmur requires further evaluation?

A
  • Grade of the murmur
  • Timing of the systolic murmur
  • Presence of continuous murmurs
  • Other physical findings or symptoms

Echocardiography is indicated for specific types of murmurs.

31
Q

Which murmurs require echocardiographic evaluation?

A
  • Diastolic murmurs
  • Continuous murmurs
  • Holosystolic murmurs
  • Late systolic murmurs
  • Murmurs associated with ejection clicks

Asymptomatic patients with these murmurs are recommended for echocardiography.

32
Q

What is recommended for asymptomatic patients with diastolic murmurs?

A

Echocardiography is recommended

This includes continuous murmurs, holosystolic murmurs, late systolic murmurs, murmurs associated with ejection clicks, or murmurs that radiate to the neck or back.

33
Q

What are the symptoms or signs that warrant echocardiography for patients with heart murmurs?

A

Symptoms or signs of:
* heart failure
* myocardial ischemia/infarction
* syncope
* thromboembolism
* infective endocarditis
* other clinical evidence of structural heart disease

Echocardiography is recommended for patients exhibiting any of these symptoms.

34
Q

What is the recommendation for asymptomatic patients with grade 3 or louder midpeaking systolic murmurs?

A

Echocardiography is recommended

This recommendation is based on the potential for underlying heart disease.

35
Q

In which cases can echocardiography be useful for asymptomatic patients?

A

Echocardiography can be useful for:
* murmurs associated with other abnormal cardiac physical findings
* murmurs associated with an abnormal ECG or chest x-ray

This is classified as Class IIa recommendation.

36
Q

When can echocardiography be useful for patients with noncardiac symptoms?

A

When symptoms and/or signs are likely noncardiac but a cardiac basis cannot be excluded by standard evaluation

This recommendation is also under Class IIa.

37
Q

What is the recommendation regarding echocardiography for patients with a grade 2 or softer midsystolic murmur?

A

Echocardiography is not recommended

This applies if the murmur is identified as innocent or functional by an experienced observer.

Cardiology Secrets (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions