Heart Sounds

Question 1

Systolic thrill found over the 4th left intercostal space:

Answer 1

VSD

Question 2

Systolic thrill found over the apex:

Answer 2

Mitral regurgitation

Question 3

Systolic thrill found over left lower sternal border:

Answer 3

Tetralogy of Fallot

Question 4

Systolic thrill found over the left upper sternal border:

Answer 4

PDA

Question 5

Diastolic thrill found over the right sternal border:

Answer 5

Aortic regurgitation

Question 6

Diastolic thrill found over the apex:

Answer 6

Mitral stenosis

Question 7

Fixed split S2:

Answer 7

ASD

Question 8

S3 (3):

Answer 8

• Passive flow (early)
• Quiet, low, difficult to hear
• CHF or volume overload

Question 9

S4 (2):

Answer 9

• Active atrial ejection (late)

- May be confused with a split S1

Question 10

Radiation to the carotid:

Answer 10

Aortic stenosis

Question 11

Radiation to the axilla:

Answer 11

Mitral murmur

Question 12

High pitch murmur:

Answer 12

High pressure gradient (VSD)

Question 13

Low pitch murmur:

Answer 13

Large volumes of blood across low pressure gradients (mitral stenosis)

Question 14

Harsh sounding murmur:

Answer 14

High pressure gradient and large volumes of blood

Question 15

Machine like murmur:

Answer 15

PDA

Question 16

Exercise/clench fists/hand grip (2):

Answer 16

• Increases ventricular volume

- Increases afterload

Question 17

Murmur that remains the same/decreases during exercise/hand grip:

Answer 17

Aortic stenosis

Question 18

Positional change or valsalva:

Answer 18

Decreases preload

Question 19

Murmurs that get louder with positional change or valsalva (2):

Answer 19

• Hypertrophic cardiomyopathy

- Mitral valve prolapse

Question 20

Leg raise or squats (3):

Answer 20

• Increase venous return
• Increases preload
• Increases PVR

Question 21

Murmurs that decrease with leg raise or squats (2):

Answer 21

• Hypertrophic cardiomyopathy

- Mitral valve prolapse

Question 22

Breathing increases:

Answer 22

Right ventricular preload

Question 23

Murmur changes during inspiration (2):

Answer 23

• Right sided murmurs increase

- Left sided murmurs decrease (except hypertrophic cardiomyopathy)

Question 24

Click (3):

Answer 24

• Sounds like splitting of S1
• Defective valve leaflets snapping or tensing when opened or shut
• Apex

Question 25

Mid-systolic click:

Answer 25

Mitral valve prolapse

Question 26

Pericardial knock - sharp S3:

Answer 26

Constrictive pericarditis

Question 27

Diastolic snap at apex:

Answer 27

Mitral stenosis (opening snap)