Heart Murmurs Uworld

Question 1

Maneuver: inspiration
Change in cardiac parameters =
Murmurs that increase =
Murmurs that decrease =

Answer 1

Change in Cardiac parameters: increased venous return to right heart, decreased venous return to left heart

Murmurs that increase: most right side murmurs

Murmurs that decrease: most left side murmurs

Question 2

Maneuver: Valsalva strain phase

Answer 2

Change in cardiac parameters: decreased preload

Murmurs that increase: MVP, HCM (decreased in LV volume)

Murmurs that decrease: most others (because flow through stenotic or regurgitant valves decreases)

Question 3

Maneuver: abrupt standing

Answer 3

Change in cardiac parameters: decreased preload

Murmurs that increase: MVP, HCM (decrease in LV volume)

Murmurs that decrease: most others (because flow through stenotic or regurgitant valves decreases)

Question 4

Maneuver: squatting

Answer 4

Change in cardiac parameters: increased preload and increased afterload

murmurs that increase: most other murmurs increase because of increased flow through stenotic or regurgitant valves

murmurs that decrease: MVP, HCM

Question 5

Maneuver: passive leg raise

Answer 5

change in cardiac parameters: increased preload and afterload

increases murmurs: most, flow across stenotic or regurgitant valves increases

decreased murmurs: MVP, HCM

Question 6

Maneuver: handgrip

Answer 6

increases afterload

increased murmurs: AR, MR, VSD (increased LV volume)

decreased murmurs: HCM (LV volume increased), AS (decreased transvalvular pressure gradient)

Question 7

crescendo-decrescendo @ RUSB

Answer 7

aortic stenosis

Question 8

holosystolic @ apex and radiates to axilla

Answer 8

mitral regurg

Question 9

crescendo-decrescendo mid-left sternal border

Answer 9

hypertrophic cardiomyopathy

Question 10

midsystolic click followed by late systolic murmur

Answer 10

mitral v. prolapse

Question 11

midsystolic with wide and fixed splitting S2

Answer 11

atrial septal defect

Question 12

holosystolic @ left sternal border

Answer 12

VSD

Question 13

decrescendo @ LUSB or RUSB

Answer 13

aortic regurg

LUSB = valvular 
RUSB = aortic root

Question 14

opening snap followed by mid diastolic rumble with presystolic accentuation

Answer 14

mitral stenosis

Question 15

machine like interscapular region posteriorly

Answer 15

PDA

Question 16

Women SQUAT to increase PRE, Women STAND to decrease Proo

Answer 16

preload decreases on standing, increases on squatting

Question 17

Standing

Answer 17

preload decreases

Question 18

Squatting

Answer 18

preload and afterload increase

Question 19

valsalva

Answer 19

preload decreases

Question 20

hand grip

Answer 20

preload and afterload both decrease