Heart sounds

Question 1

Mitral stenosis murmur

Answer 1

Murmur 
opening snap (loud S1), when MS worsens will be followed by low pitched rumbling mid-diastolic murmur (best heard with bell) while patient is in the left lateral decubitus position. 

non-radiating murmur

high thrombotic risk if pt has Afib

Etiology most often after episode of rheumatic fever

Question 2

Aortic stenosis murmur

Answer 2

Murmur: harsh systolic crescendo-decrescendo murmur at RSB, radiating to the neck, +/- thrill
Delayed carotid pulses

Question 3

Grades (intensities)

Answer 3

I - Heard in a quiet room by an expert examiner
II - Heard by most examiners
III - Loud murmur without thrill
IV - Loud murmur WITH a THRILL
V - Thrill with a very loud murmur audible with stethoscope placed lightly over the chest
VI - Thrill with a very loud murmur audible even with the stethoscope slightly away from the chest

Question 4

MVP

Answer 4

Murmur: mid-systolic click(s), may hear late-systolic murmur

most common type of MR, ”Floppy” or myxomatous mitral valve

often pts are tall, thin, female, hx of Marfan’s or Ehlers Danlos syndrome

Question 5

MR

Answer 5

Murmur: holosystolic, apical, blowing murmur that radiates to the axilla is classic, frequently associated with a thrill

possible S3 – rapid filling of LV by large volume of blood accumulated in the LA during systole

Question 6

AR

Answer 6

Murmur: blowing diastolic decrescendo murmur LSB

Water hammer pulse – rapid upstroke, quick collapse
Austin Flint Murmur – mid-late diastolic rumble heard at the apex in severe AR

Widened pulse pressure (e.g. 170/60)

Question 7

TS

Answer 7

Murmur: diastolic murmur over the LSB with inspiration

Question 8

TR

Answer 8

Murmur: pansystolic murmur at the 3rd to 4th ICS at the LSB, increases with inspiration (if a murmur is present)

Question 9

Pulmonary Stenosis

Answer 9

Murmur: harsh systolic crescendo-decrescendo murmur best at 3-4 ICS.