Heart sounds misc

Question 1

Causes of a loud S1

Answer 1

Mitral stenosis Left-to-right shunts

short PR interval, atrial premature beats hyperdynamic states

Question 2

Causes of a quiet S1

Answer 2

Mitral regurgitation

Question 3

Causes of a loud S2

Answer 3

Hypertension: systemic (loud A2) or pulmonary (loud P2), hyperdynamic states, atrial septal defect without pulmonary hypertension

Question 4

Causes of a soft S2

Answer 4

Aortic stenosis

Question 5

Causes of fixed split S2

Answer 5

Atrial septal defect

Question 6

Causes of a widely split S2

Answer 6

Deep inspiration, RBBB, pulmonary stenosis, severe mitral regurgitation

Question 7

Causes of a reversed (paradoxical) split S2 (P2 occurs before A2)

Answer 7

LBBB, severe aortic stenosis, right ventricular pacing, WPW type B (causes early P2), patent ductus arteriosus

Question 8

Ejection systolic murmurs

Answer 8

Aortic stenosis, pulmonary stenosis, hypertrophic obstructive cardiomyopathy, atrial septal defect, tetralogy of Fallot

Question 9

Holosystolic (pansystolic) murmurs

Answer 9

mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character),ventricular septal defect (‘harsh’ in character)

Question 10

Late systolic murmurs

Answer 10

Mitral valve prolapse, coarctation of aorta

Question 11

Early diastolic murmurs

Answer 11

Aortic regurgitation (high-pitched and ‘blowing’ in character), Graham-Steel murmur (pulmonary regurgitation, again high-pitched and ‘blowing’ in character)

Question 12

Graham-Steel murmur

Answer 12

Pulmonary regurgitation, high-pitched and ‘blowing’ in character

Question 13

Mid-late diastolic murmur

Answer 13

Mitral stenosis (‘rumbling’ in character), Austin-Flint murmur (severe aortic regurgitation, again is ‘rumbling’ in character)

Question 14

Austin-Flint murmur

Answer 14

Severe aortic regurgitation, again is ‘rumbling’ in character

Question 15

Continuous machine-like murmur

Answer 15

Patent ductus arteriosus