Heart sounds

Question 1

Pansystolic murmur radiates to the left axilla? causes?

Answer 1

Mitral Regurg.

CX: IE, rheumatic HD, acute Mi, congenital defects, cardiomyopathy.

Question 2

This is heard in the left mid axillary line in the 5th IC space. what is it?

Answer 2

Pansystolic murmur, described as high pitched and blowing. 5th ICS in left mid axillary is the mitral area. this is mitral regurg

Question 3

This is heard best in the left sternal border what is this?

Answer 3

describbed as high pitched and blowing in charater.

Tricuspid regurg - radiates to the right sternal border.

CX: RV dilation, rheumatic fever, IE< carcinoid syndrome, congential

Question 4

Pansystolic murmur harsh in character?

Answer 4

VSD

Question 5

What is this?

Answer 5

Holosystolic/ pansystolic murmer. continuous through systole.

(BURRRRR)

Question 6

What is this?

Answer 6

Continuous machine -like murmer in PDA.

Question 7

This is heard loudest on inspiration. what is it?

Answer 7

pansystolic, louder on inspiration is TR

(bc higher venous return, more volume in RA)

Question 8

What murmur is this? When could it be heard?

Answer 8

Early diastolic. high pitcched and blowing.

heard in AR, PR (graham-steel murmur)

AR: heard best in left parasternal border 2nd IC space

Question 9

Features of pulmonary regurg?

Answer 9

decrescendo early murmur loudest on left sternal edge, similar to AR. loudes on inspiration.

CX: pulmonary hTN< IE< congenital heart disease

Question 10

What is this?

Answer 10

Normal heart sound

Question 11

What is this?

Answer 11

Loud S1: due to larger AV valves needing to shut forcefully.

found in

mitral stenosis

left-to-right shunts

short PR interval, atrial premature beats

hyperdynamic states

Question 12

What is this?

Answer 12

Fixed -split S2:

ASD, pulmonary HTN, Right heart failure

normal in deep inspiration

Question 13

What is this?

Answer 13

SPlit S1 sound, best heard in tricuspid area.

means a delay in closing of tricupsid or mitral valve. can be normal.

also:

RBBB

Lower frequency is S4 sound - pathological

Question 14

This is louder on inspiration. what could it be?

Answer 14

ejection systolic murmer

pulmonary stenosis/ ASD

TOF

Question 15

What is this?

Answer 15

late-systolic murmur. Mitral valve prolapse best heard at cardiac apex. or COA.

prolapse: AF: connective tissue disease. loudest on inspiration.

Question 16

This is louder on expiration. what is it?

Answer 16

crescendo descrendo ejection-systolic murmur. Aortic stenosis.

S1-burr-louder S2, most common, slow rising pulse, BP - systolic and diastolic similar, exertional syncope.

heard best in Aoritc area. (right sternal border in the 2nd IC space.

AF: pulses parvus et tardus

CX: calcified and bicuspid aortic valves.

could also be: TOF, HOC, AS

Question 17

A murmur radiates to the carotids. what is it?

Answer 17

AS. louder on expiration

Question 18

This is best heard in the 3rd/4rth IC space, left parasternal border.

Answer 18

AR/ PR.

CX: congenital bicuspid, IE< RHD< aortic dissection, Marfans/ connective tissue disease, aortitis

anything affecting the valve/ causing aortic rooth dilation.

Question 19

Other signs of AR in the body?

Answer 19

decrescendo early diastolic murmur on left sternal edge,

collapsing pulse

displaces hyperdynamic apex beat

head bobbing with heart beat

nail bed pulsations

uvula pulsations with each heart beat

collapsing carotid arteries in the neck and isible distension

Question 20

What is this?

Answer 20

severe AR, austin flint murmer.

Question 21

What is this?

Answer 21

Mid - late Diastolic murmur. heard in MS with rumbling character. or an austin flint.

comes with a loud S1 and snap of valve

LUB dub-durrr

Question 22

What is this?

Answer 22

S3 sound. caused by diastolic filling of the ventrile. normal in <30YO-50YO women.

heard in left ventricular failure (dilated cardiomyopathy, contrstictve pericarditis, MR)

Question 23

This becomes louder on valsava manourver and heard loudest on apex.

Answer 23

MS: most commonly RHD

AF: AF, loud S1, malar flush

Question 24

Manouver to hear AR better?

Answer 24

patient sat up and askd to lean forward. expiration and hold their breath to hear the early-diastolic

Question 25

Manouver to hear the MS murmur better?

Answer 25

roll patient onto their left side to hear the mid-late diastolic rumble on their mitral area (apex)

Question 26

What does crescendo decrescendo mean?

Answer 26

getting louder and then getting queiter

Question 27

What grade is the murmur when you feel a palpable thrill?

Answer 27

grade 4

Question 28

What are grades 1-3 of the murmer?

Answer 28

1 - difficult to hear

2- quiet

3 - easy to hear

Question 29

What is a grade 5 murmer?

Answer 29

can hear it with stethoscope barely touching the body.

Question 30

When do you get left atrial hypertrophy?

Answer 30

Mitral stenosis (more muscle means more force needed)

Question 31

When do you get left Ventricular hypertrphy?

Answer 31

Aortic stenosis

Question 32

What causes left atrial dilation

Answer 32

MR (dilation means leaky valve)

Question 33

Cx of left ventricular dilaiton?

Answer 33

Aortic regurg

Question 34

What does a rumbling low pitched murmur tell you about the BF?

Answer 34

blood flows slowly because of a stenotic valve (eg. MS, low pitched rumbling mid-late diastolic)

Question 36

WHY DO YOU get a malar flush in MS?

Answer 36

backflow of blood into the pulmonary system, increased CO2, vasodilation, flushing of cheeks

also get AF.