Heart Sounds

Question 1

Murmur with Aortic Regurg

Answer 1

Decrescendo diastolic

Question 2

Murmur with Mitral Stenosis

Answer 2

Opening Snap + late diastolic rumble

Question 3

Murmur with Aortic Stenosis

Answer 3

Ejection Click + Systolic Crescendo/Decrescendo

Question 4

Murmur with Mitral Valve PRolapse

Answer 4

Midsystolic click + Systolic Crescendo –LOUD OVER APEX

Question 5

Murmur with Mitral Regurg

Answer 5

Holosystolic - LOUD OVER APEX

Question 6

Murmur with Tricuspid Regurg

Answer 6

Holosystolic - Loud over Tricuspid

Question 7

Murmur with VSD

Answer 7

Holosystolic –LOUD OVER TRICUSPID

Question 8

Murmur with PDA

Answer 8

Continuous Machine-like murmur

Question 9

Wide Split S2

Answer 9

Pulmonic stenosis or Right bundle block

Question 10

Fixed Split S2

Answer 10

ASD

Question 11

Paradoxical Split S2

Answer 11

Aortic Stenosis or Left bundle block

Question 12

S3 - noise represents what?

Answer 12

Sudden deceleration of blood filling the ventricle as it reaches its elastic limit

Question 13

S4 - noise represents what?

Answer 13

Rush of blood striking a stiff ventricular wall

Question 14

S3 seen with what pathologies?

Answer 14

1) CHF 2) MR 3) dilated cardiomyopathy – increased filling pressures

Question 15

S4 seen with what pathologies?

Answer 15

1) RESTRICTIVE cmpthy 2) HYPERTROPHIC cmpthy 3) LV hypertrophy –Stiff Wall

Question 16

What does handgrip maneuver make LOUDER?

Answer 16

AR, MVP, MR, VSD

Question 17

What does handgrip maneuver make QUIETER?

Answer 17

AS, Hypertrophic cardiomyopathy murmurs

Question 18

What does Valsalva make LOUDER?

Answer 18

AS, MVP

Question 19

What does Squatting make QUIETER?

Answer 19

MVP, Hypertrophic Cardiomyopathy murmurs

Question 20

What does Squatting make LOUDER?

Answer 20

MR

Question 21

What does squatting help with symptomatically?

Answer 21

Tetralogy of Fallot - VSDs are normally L to R but the pulm HTN makes it R-to-L generating a cyanotic tet spell. Squatting increases afterload, and htus LV pressure, reversing shunt.