Heart sounds and Murmurs

Question 1

What causes the first heart sound

Answer 1

• closure of the mitral and tricuspid valve

Question 2

What happens after the first heart sound

Answer 2

Beginning of ventricular systole

Question 3

where is the loudest point that the first heart sound is heard

Answer 3

loudest at the apex and lower left sternal border

Question 4

what parts of the stethoscope can the first heart sound be heard with

Answer 4

Can be heard easily with both the bell and diaphragm

Question 5

What causes the second heart sound

Answer 5

• closure of the aortic valve and pulmonary valve

Question 6

what happens at the end of the second heart sound

Answer 6

end of ventricular systole

Question 7

where can the second heart sound be easily heart

Answer 7

loudest at the base

Question 8

what part of the stethoscope is the second heart sound heard with

Answer 8

For the second heart sound the diaphragm is used with the stethoscope usually best placed at the base

Question 9

what is S3 due to

Answer 9

Pathological

• third heart sound
• blood is coming into contact with a dilated ventricle either due to mitral regurgitation or heart failure with dilated cardiomyopathy

Question 10

Name two causes of S3 heart sound

Answer 10

Blood is coming into contact with a dilated ventricle either due to

• mitral regurgitation
• heart failure with dilated cardiomyopathy

Question 11

what is S4 heart sound due to

Answer 11

Blood pushing against a non-compliant ventricular during arterial contraction (when ventricle is still in diastole)

• left ventricular hypertrophy
• post-MI fibrosis
• failure of relaxation - diastolic heart failure

Question 12

where can you hear 
- aortic 
- pulmonary 
- tricuspid 
- mitral 
heart sounds

Answer 12

• aortic = right 2nd intercostal space sternal edge
• pulmonary = left 2nd intercostal space sternal edge
• tricuspid = left 4th intercostal space sternal edge
• mitral = 5th intercostal space mid-axillary line

Question 13

What are the non pathological heart murmurs

Answer 13

Functional murmur
- no structural heart disease is detected and there is a plausible physiological explanation for the murmur (e.g. anaemia)

Innocent murmur
- no structural heart disease is detected and no obvious physiologic explanation for the murmur is identified

Question 14

what are the grades of heart murmur

Answer 14

1
- soft murmur heard only under quiet conditions

2
- soft murmur heard under even noisy conditions

3
- easily hear prominent murmurs

4
- round murmur associated with a thrill - max for diastolic murmurs

5
- loud murmur with the edge of the stethoscope tilted against the chest plus a thrill

6
- very loud murmur that can be heard 5mm to 10mm from the chest plus a thrill

Question 15

what are systolic murmurs

Answer 15

• Murmurs that occur in systole

Question 16

name systolic murmurs

Answer 16

• early ejection systolic
• mid systolic
• pan systolic
• early systolic
• late systolic

Question 17

describe an early ejection systolic murmur

Answer 17

Begins with S1 reduces in volume and ends well before S2

Question 18

describe a mid systolic murmur

Answer 18

• begins after S1 and ends before S2

Question 19

describe a pansystolic murmur

Answer 19

• begins with S1 and occupies all of systole reaching S2

Question 20

describe an early systolic murmur

Answer 20

starts with S1 and ends well before S2

Question 21

describe a late systolic murmur

Answer 21

begins in mid to late systole and rises to S2

Question 22

List the diastolic murmurs

Answer 22

• early diastole
• mid-diastole
• late diastole

Question 23

describe early diastole murmur

Answer 23

• begins with S2

Question 24

Describe a mid-diastolic murmur

Answer 24

Begins sometime later after S2

Question 25

Describe a late diastolic murmur

Answer 25

Begins immediately before S1

Question 26

What is a continuous murmur

Answer 26

• murmur that starts in systole and continues through S2 into all or part of diastole

Question 27

name heart valve problems that cause systolic murmurs

Answer 27

• aortic stenosis

- mitral regurgitation

Question 28

name heart valve problems that cause diastolic murmurs

Answer 28

• aortic regurgitation

- mitral stenosis

Question 29

what techniques can you use to increase the sound of right sided murmurs

Answer 29

• breath in and hold it in - right side murmurs

Question 30

What techniques can you use to increase the sound of left sided murmurs

Answer 30

• breath in and breath out and keep it out - left sided murmur

Question 31

What causes valvular disease

Answer 31

• congenital - mostly affect the aortic or pulmonic valve

Acquired

• rheumatic fever
• infective endocarditis
• coronary artery disease
• heart attack
• cardiomyopathy
• syphilis
• hypertension
• aortic aneurysms
• connective tissue diseases

Question 32

Describe what mitral regurgitation sounds like

Answer 32

• apical systolic murmur transmuted to the axilla
• listen at the apex
• pansystole

Question 33

describe what the mitral stenosis murmur sounds like

Answer 33

• opening snap
• apical pre-systolic murmur
• accentuated first heart sound (S1)

Question 34

describe what mitral valve prolapse sounds like

Answer 34

• late systolic murmur
• mid-systolic click
• heard mainly lower left sternal border

Question 35

what does aortic regurgitation sound like

Answer 35

• listen at the 3rd/4th left interspace along sternal border and aortic area
• high pitched blowing decrescendo early diastolic murmur
• better heard with patient sitting, leaning forward in full expiration

Question 36

what does aortic stenosis sound like

Answer 36

• radiates to the carotids
• loud rough ejection systolic murmur
• diminished or absent S2

Question 37

What does tricuspid regurgitation sound like

Answer 37

• pan systolic blowing murmur

- accentuated by inspiration

Question 38

what can cause a continuous murmur

Answer 38

patient ducts arteriosus

Question 39

Where should you listen to a continuous murmur

Answer 39

• listen below left clavicle