Heart sounds/murmurs

Question 1

What is a heart murmur?

Answer 1

Sound produced when blood flowing through the heart is turbulent.

Question 2

Causes of heart murmurs

Answer 2

1. Abnormal narrowing (e.g. stenosis)
2. Blood flowing the wrong direction (regurgitation)
3. Abnormal connection between parts of the heart (mixing of blood or too much blood in a heart chamber)
4. Blood flowing faster through the heart

Question 3

Transmitted heart murmurs

Answer 3

Structural defects result in turbulence that continues to be heard in the direction of blood flow

Question 4

Examples of transmitted murmurs

Answer 4

Aortic stenosis radiates to carotid arteries

Mitral regurgitation radiates to the axilla

Question 5

Cause of systolic murmur

Answer 5

1. Aortic/pulmonary stenosis
2. Mitral and tricuspid regurgitation
3. Mitral valve prolapse - systolic murmur with opening click

Question 6

Cause of early diastolic murmur

Answer 6

Aortic and pulmonary regurgitation

Question 7

Cause of mid/late-diastolic murmur

Answer 7

Mitral and tricuspid stenosis

Question 8

Ejection systolic (crescendo-decrescendo) murmur

Answer 8

Aortic and pulmonary stenosis

Question 9

Pansystolic murmur

Answer 9

Mitral and tricuspid regurgitation

Question 10

Other causes of ejection systolic murmurs

Answer 10

Aortic sclerosis and Hypertrophic obstructive cardiomyopathy (HOCM).
Atrial septal defects and pulmonary stenosis

Question 11

Characteristics of aortic sclerosis and HOCM

Answer 11

Both loudest in aortic valve area during expiration.

Aortic stenosis radiates to carotids, HOCM and aortic sclerosis do not

Question 12

Characteristics of atrial septal defects and pulmonary stenosis

Answer 12

Both loudest in pulmonary region

Atrial septal defects cause wide and fixed splitting of S2 whereas pulmonary stenosis does not

Question 13

Aortic area loudest heard?

Answer 13

In 2nd intercostal space right sternal edge

Question 14

Pulmonary area loudest heard?

Answer 14

2nd intercostal space left sternal edge

Question 15

Tricuspid area loudest heard?

Answer 15

4th intercostal space left sternal edge

Question 16

Mitral area loudest heard ?

Answer 16

5th intercostal space left mid-clavicular line

Question 17

Movement exaggeration: aortic valve

Answer 17

Sitting forwards

Question 18

Movement exaggeration: Mitral valve

Answer 18

Left lateral decubitis position

Question 19

Inspiration = which heart murmurs louder

Answer 19

Right side valve lesions because intrathoracic pressure reduced - more blood into right side

Question 20

Expiration = which heart murmurs louder

Answer 20

Left sided heart valve lesions - intrathoracic pressure increases, pulmonary vessels contract, blood forced into LA

Question 21

Aortic stenosis radiates to

Answer 21

Carotid artery

Question 22

Mitral regurgitation radiates to

Answer 22

Axilla

Question 23

Aortic regurgitation radiates to

Answer 23

Left sternal edge

Question 24

Pulmonary stenosis radiates to

Answer 24

Left shoulder/infra-clavicular region

Question 25

Associations of aortic stenosis

Answer 25

Slow-rising narrow pulse pressure

Question 26

Associations of pulmonary stenosis

Answer 26

Right HF (RV heave, tricuspid regurgitation, raised JVP) 
Widely split S2

Question 27

Associations of tricuspid regurgitation

Answer 27

Large ‘v-waves’ in JVP, hepatic pulsations

Question 28

Associations of aortic regurgitation

Answer 28

Collapsing pulse, wide pulse pressure

Question 29

Association of pulmonary regurgitation

Answer 29

Right HF