Heart Sounds

Question 1

Crescendo-decrescendo systolic ejection murmur (maybe with ejection click)

Answer 1

aortic stenosis

Question 2

Holosystolic, high-pitched “blowing murmur”

Answer 2

Mitral/Tricuspid regurg

Question 3

Midsystolic click followed by late systolic crescendo murmur

Answer 3

mitral valve prolapse (mid-systolic click is from sudden tensing of chordae tendineae)

Note: that an early systolic click is a sign of bicuspid aortic valve prior to stenosis

Question 4

Holosystolic, harsh-sounding murmur. Loudest at tricuspid area.

Answer 4

VSD

Question 5

High-pitched “blowing” early diastolic decrescendo murmur

Answer 5

aortic regurgitation

Question 6

Diastolic opening snap followed by rumbling late diastolic murmur

Answer 6

mitral stenosis

Question 7

Continuous machine-like murmur

Answer 7

PDA

Question 8

Pulsus parvus et tardus is associated with:

Answer 8

aortic regurgitation (pulses are weak with delayed peak)

Question 9

What symptoms is aortic stenosis assoc with:

Answer 9

SAD - syncope, angina, dyspnea on exertion

Question 10

Radiates toward axilla

Answer 10

mitral regurg

Question 11

Radiates towards right sternal border

Answer 11

tricuspid regurg

Question 12

Most frequent valvular lesion

Answer 12

mitral prolapse

Question 13

Myxomatous degeneration (Marfan or Ehlers-Danlos) causes:

Answer 13

mitral prolapse

Question 14

Signs of aortic regurgitation

Answer 14

• hyperdynamic pulse
• head bobbing when severe
• Wide pulse pressure

Question 15

Rheumatic fever usually causes:

Answer 15

Mitral stenosis (which can lead to LA dilation and compression of L. recurrent laryngeal nerve)

Question 16

What indicates a more severe mitral stenosis?

Answer 16

• less time between S2 and opening snap = more severe

Note: LA pressure&raquo_space; LV pressure during diastole

Question 17

Radiates to carotids

Answer 17

aortic stenosis

Question 18

Causes of aortic regurg:

Answer 18

• aortic root dilation
• bicuspid aortic valve (which also does stenosis)
• endocarditis
• rheumatic fever

Question 19

Fixed splitting

Answer 19

ASD (from left-right shunt increases flow through pulmonic valve that delays closure)

Question 20

What is an S3 sound? What does it indicate?

Answer 20

S3- early diastole from rapid ventricular filling

Assoc: increase filling pressure (mitral regurge, HF, dilated ventricles, normal in kids)

Question 21

What is an S4 sound?

Answer 21

S4- late diastole (“atrial kick” from hitting stiff ventricle)

Assoc: hypertrophy (from HTN)

Question 22

Order of valves closing in normal splitting and why this occurs

Answer 22

1. aortic close
2. pulmonic close (S2)

Increased venous returns during inspiration, increases RV filling and delays the P closing

Question 23

Wide splitting causes

Answer 23

• delay in RV emptying/pulmonic valve closure

pulmonic stenosis, RBBB

Question 24

Paradoxical splitting causes

Answer 24

• delay in aortic valve closure (P sound before A)

aortic stenosis, LBBB

Question 25

Inspiration and flow in heart

Answer 25

increases in venous return to RA (thus increases right heart sounds)

Question 26

Hand grip and flow in heart

Answer 26

increases in afterload

Question 27

Valsalva and flow in heart

Answer 27

decreases preload (thus decreasing intensity of most murmurs except for HCM)

Question 28

Standing up and flow in heart

Answer 28

decreases preload (like valsalva)

Question 29

Rapid squatting

Answer 29

increases preload (venous return) and afterload

Question 30

Systolic heart sounds

Answer 30

• A/P stenosis, M/T regurg, VSD, MVP

Question 31

Diastolic heart sounds

Answer 31

• A/P regurg, M/T stenosis

Question 32

Presystolic murmur (think opening snap and diastolic rumble) that disappears with a. fib

Answer 32

M/T stenosis

Question 33

Systolic ejection murmur in HCM LVOT vs aortic stenosis

Answer 33

HCM LVOT murmur: increases when standing (less blood filling LV = more obstruction)

Aortic stenosis = standing decreases afterload and thus reduces murmur