Heart Sounds

Question 1

S1

Answer 1

closure of the AV valves

Question 2

S2

Answer 2

closure of the aortic and pulmonary valves

Question 3

S3

Answer 3

heard during rapid ventricular filling and may represent tensing of chordae tendineae and AV ring during ventricular relaxation and filling

Question 4

S4

Answer 4

sometimes noted during atrial contraction, caused by vibration of the ventricular wall during atrial contraction

Question 5

Split S1

Answer 5

the mitral and tricuspid components of S1 have become separated enough to be distinguished as two separate sounds

Question 6

Split S2

Answer 6

the aortic and pulmonic components of S2 have become separated enough to be distinguished as two separate sounds. This happens normally during inspiration

Question 7

Opening Snap

Answer 7

a high-pitch additional sound may be heard after the A2 (aortic) component of the second heart sound (S2), which correlates to the forceful opening of the mitral valve

Question 8

loud ejection click that decreases with inspiration followed by a loud, harsh systolic murmur (or high pitched systolic ejection murmur) with a thrill that radiates to the left shoulder and worsens with inspiration

Answer 8

Pulmonary Valve Stenosis

Question 9

a continuous murmur heard superiorly mid-line in the back or over the left anterior chest

Answer 9

Coarctation of the Aorta

Question 10

first heart sound normal or split, mid-systolic murmur, split second heart sound, and a mid-diastolic murmur along the left sternal border

Answer 10

Atrial Septal Defect

Question 11

systolic ejection murmur with a widely split second heart sound

Answer 11

Atrial Septal Defect

Question 12

Harsh, holosystolic murmur heard best along left sternal border

Answer 12

Ventricular Septal Defect

Question 13

harsh systolic ejection murmur

Answer 13

Tetralogy of Fallot

Question 14

continuous rough “machinery” murmur and a loud S2 heard best in the first and second intercostal spaces along the left sternal border

Answer 14

Patent Ductus Arteriosus

Question 15

prominent S1, opening snap after S2, and apical diastolic rumble heard best at the apex with the patient in the left lateral position

Answer 15

Mitral Stenosis

Question 16

high pitched blowing pansystolic murmur prominent at the apex and radiating to the axilla; prominent third heart sound (mid-systolic click)

Answer 16

Mitral Regurgitation

Question 17

mid-to-late systolic click that is accentuated during the Valsalva Maneuver and standing

may hear a late systolic murmur

Answer 17

Mitral Valve Prolapse

Question 18

harsh crescendo-decrescendo systolic ejection murmur often radiating to the neck and apex

soft, absent, or paradoxically split S2

sometimes with thrill along left sternal border

Answer 18

Aortic Stenosis

Question 19

soft systolic flow murmur and high-pitched decrescendo diastolic murmur with a late diastolic rumble heard along the left sternal border (Austin Flint Murmur)

Answer 19

Aortic Regurgitation

Question 20

Right-sided murmurs ____ with inspiration.

Answer 20

Increase - called Cavalio’s Sign

exception: ejection click of Pulmonary Valve Stenosis

Question 21

Left-sided murmurs _____ with exhalation.

Answer 21

Increase

Question 22

Most murmurs increase with more _____.

Answer 22

Preload (squatting or leg-lifts)

exceptions: Mitral Valve Prolapse and hypertrophic cardiomyopathy

Question 23

Pansystolic Murmurs

Answer 23

Mitral Regurgitation, Tricuspid Regurgitation, and Ventricular Septal Defect

Question 24

Continuous “Machinery” Murmur

Answer 24

Patent Ductus Arteriorsus

Question 25

diastolic rumble along left sternal border that increases with inspiration

Answer 25

Tricuspid Stenosis

Question 26

S3 gallop; high-pitched holosystolic, pansystolic murmur, loudest at the fourth intercostal space in the parasternal region that increases with inspiration

decreases with standing or Valsalva

short early diastolic flow rumble

Answer 26

Tricuspid Valve Regurgitation

Question 27

widely split S2; loud diastolic decrescendo murmur (Graham-Steell murmur); Murmur increases with inspiration

Answer 27

Pulmonary Valve Regurgitation

Question 28

reverse splitting of S2, presence of S3 or S4, new or worsening apical systolic murmur, or rales or cackles

Answer 28

Unstable Angina