Heart Sounds

Question 1

Which is usually softer: S1 or S2?

Answer 1

S1 is softer

Question 2

Which is usually softer: right or left sided heart sounds?

Answer 2

Right sided

Question 3

Where are S3 and S4 best heard? Which side of the stethoscope should be used?

Answer 3

At the apex, with the bell

Question 4

How are systolic murmurs graded?

Answer 4

1-6

Question 5

How are diastolic murmurs graded?

Answer 5

1-4

Question 6

What is the naming convention for murmurs?

Answer 6

Grade cycle intensity radiation

Question 7

What are the three causes of pulmonic stenosis?

Answer 7

• Congenital heart structural disease
• Rheumatic valvular disease
• Carcinoid syndrome

Question 8

What are the two major causes of tricuspid regurgitation?

Answer 8

Infection

Rheumatic fever

Question 9

What are the four major causes of pulmonic regurgitation?

Answer 9

• Rheumatic valvular disease
• Carcinoid syndrome
• Pulmonary HTN
• CT diseases

Question 10

What are the three major causes of tricuspid stenosis?

Answer 10

• Rheumatic valvular disease
• Congenital heart structural disease
• Age/calcification

Question 11

What are the three major causes of aortic stenosis?

Answer 11

• Age/calcification
• Congenital disease
• Infective endocarditis

Question 12

Why is it that pts with Hypertrophic cardiomyopathy are better with higher volumes?

Answer 12

Increased filling of the ventricle makes the septal hypertrophy a more minor contributor to outflow obstruction

Question 13

Where is the murmur from HCM heard best? Why?

Answer 13

Apex d/t backflow from

Question 14

What are the four major causes of aortic regurgitation?

Answer 14

• Endocarditis
• Root dilation
• Congenital (bicuspid valve)
• CT disorder

Question 15

Where does mitral stenosis radiate to?

Answer 15

Precordial area

Question 16

Does increased volume return make the murmur with mitral stenosis worse or better?

Answer 16

worse

Question 17

What are the two major causes of mitral stenosis?

Answer 17

Infective endocarditis

Calcific changes

Question 18

What happens to the OS with mitral valve prolapse when there is decreased systolic volumes?

Answer 18

Moves OS earlier

Question 19

What happens to the OS with mitral valve prolapse when there is increased systolic volumes?

Answer 19

Moves the OS later

Question 20

What is the effect of aortic regurgitation on the murmurs from a VSD and mitral regurg?

Answer 20

Increases d/t increased LV filling/volume

Question 21

What is the effect of aortic regurgitation on HCM murmur? Why?

Answer 21

Decreases, since it increases LV filling

Question 22

What is the effect of standing with HCM?

Answer 22

Increases murmur d/t decreased LV filling

Question 23

What is the effect of sitting/lying down with HCM?

Answer 23

Decreases murmur d/t increased LV filling

Question 24

What is the effect of the valsalva maneuver on HCM?

Answer 24

Bearing down reduces return and LV volume, increasing stenosis

Question 25

What is the effect of hand grip on mitral regurgitation?

Answer 25

Increases SVR and LV pressure, thereby increasing the pressure gradient between the LV and LA

Question 26

What position of the patient is best for hearing S3 and S4?

Answer 26

Left lateral recumbent

Question 27

What is the treatment for mitral regurg? Why?

Answer 27

• ACEIs
• Diuretics

Reduce the ssx of HF

Question 28

What is the treatment for dilated cardiomyopathy?

Answer 28

• Diuretics
• ACEIs
• Beta blockers

Question 29

What is the treatment for aortic stenosis?

Answer 29

Positive inotropes

Question 30

What is the treatment for mitral regurg?

Answer 30

Decrease BP

Increase inotropy

Question 31

What is the treatment for mitral stenosis?

Answer 31

Increase