Heart Sounds, Murmurs and JVP

Question 1

Holosystolic (Timing)

Heart Murmurs

Answer 1

• MR
• TR
• VSD

Question 2

Early systolic (Timing)
(Heart Murmurs)

Answer 2

AS

Question 3

Late systolic (Timing)
(Heart Murmurs)

Answer 3

MVP

Question 4

Immediate or early diastolic (Timing)

Heart Murmurs

Answer 4

AR

Question 5

Late diastolic (Timing)
(Heart Murmurs)

Answer 5

MS

Question 6

Continuous (Timing)

Heart Murmurs

Answer 6

PDA

Question 7

High pitched “blowing murmur” (Pitch)

Heart Murmurs

Answer 7

• MR
• TR
• AR (decrescendo)

Question 8

Crescendo-decrescendo (Pitch)

Heart Murmurs

Answer 8

AS

Question 9

Harsh-sounding murmur (Pitch)

Heart Murmurs

Answer 9

VSD

Question 10

Crescendo (Pitch)

Heart Murmurs

Answer 10

MVP

Question 11

Rumbling murmur (Pitch)
(Heart Murmurs)

Answer 11

MS

Question 12

Machine-like (Pitch)

Heart Murmurs

Answer 12

PDA

Question 13

Ejection click (Associated sound)
(Heart Murmurs)

Answer 13

AS

Question 14

Midsystolic click (Associated sound)
(Heart Murmurs)

Answer 14

MVP

Question 15

Opening snap (Associated sound)
(Heart Murmurs)

Answer 15

MS

Question 16

At apex (Where is loudest)
(Heart Murmurs)

Answer 16

• MR

- MVP

Question 17

At tricuspid area (Where is loudest)

Heart Murmurs

Answer 17

• TR

- VSD

Question 18

At left infraclavicular area (Where is loudest)

Heart Murmurs

Answer 18

PDA

Question 19

At S2 (When is loudest)
(Heart Murmurs)

Answer 19

• MVP

- PDA

Question 20

Axilla (Radiation)

Heart Murmurs

Answer 20

MR

Question 21

Right sternal border (Radiation)

Heart Murmurs

Answer 21

TR

Question 22

Carotids/heart base (Radiation)

Heart Murmurs

Answer 22

AS

Question 23

Pulsus parvus et tardus (Associated physical sings)

Heart Murmurs

Answer 23

AS

Question 24

Bounding pulses and head bobbing (Associated physical sings)

Heart Murmurs

Answer 24

AR

Question 25

IHD, MVP, LV dilation, rheumatic fever, infective endocarditis (Causes) (Heart Murmurs)

Answer 25

MR

Question 26

RV dilation, rheumatic fever, infective endocarditis (Causes) (Heart Murmurs)

Answer 26

TR

Question 27

Age related calcification or bicuspid valve (Causes) | Heart Murmurs

Answer 27

AS

Question 28

Myxomatous degeneration, rheumatic fever, chordae rupture (Causes) (Heart Murmurs)

Answer 28

MVP

Question 29

Aortic root dilation, bicuspid valve, rheumatic fever, infective endocarditis (Causes) (Heart Murmurs)

Answer 29

AR

Question 30

``` Rheumatic fever (Causes) (Heart Murmurs) ```

Answer 30

MS

Question 31

Congenital rubella, prematurity (Causes) | Heart Murmurs

Answer 31

PDA

Question 32

Inspiration (Effects on heart sounds and murmurs) | Maneuver

Answer 32

Increase intensity of right heart sounds

Question 33

Expiration (Effects on heart sounds and murmurs) | Maneuver

Answer 33

Increase intensity of left heart sounds

Question 34

``` Hand grip (increase systemic vascular resistance; thereby decrease left ventricular emptying [fuller LV]) (Effects on heart sounds and murmurs) (Maneuver) ```

Answer 34

- Increase intensity of MR, AR, and VSD murmurs | - Decrease intensity of AS, MVP and HOCM systolic murmurs

Question 35

Valsalva or Standing (decrease venous return [diuretic effect]) (Effects on heart sounds and murmurs) (Maneuver)

Answer 35

- Decrease intensity of most heart murmurs | - Increase intensity of MVP and HCOM systolic murmurs

Question 36

``` Rapid squatting (increase venous return and preload, increase afterload with prolonged squatting) (Effects on heart sounds and murmurs) (Maneuver) ```

Answer 36

Decrease intensity of MVP and HCOM systolic murmurs

Question 37

Wide splitting of heart sounds (Causes) | Heart Sounds

Answer 37

- Pulmonic stenosis | - RBBB

Question 38

Fixed splitting of heart sounds (Causes) | Heart Sounds

Answer 38

ASD

Question 39

Paradoxical splitting of heart sounds (Causes) | Heart Sounds

Answer 39

- AS | - LBBB

Question 40

Elevated JVP | Causes

Answer 40

- Congestive heart failure - Cor pulmonale - Pulmonary embolism - Right ventricular infarction - Tricuspid valve disease - Cardiac tamponade - Constrictive pericarditis - Hypertrophic/restrictive cardiomyopathy - Superior vena cava obstruction - Iatrogenic fluid overload, particularly in surgical and renal patients

Question 41

Elevated JVP with absent pulsation (JVP waves) | Causes

Answer 41

Superior vena cava syndrome

Question 42

Large 'a' wave (JVP waves) | Causes

Answer 42

Increased atrial contraction pressure - Tricuspid valve stenosis - Right heart failure - Pulmonary hyper tension

Question 43

Cannon 'a' wave (JVP waves) | Causes

Answer 43

Atrial contraction against closed tricuspid valve - Atrial flutter - Premature atrial rhythm (tachycardia) - Third degree heart block - Ventricular ectopics - Ventricular tachycardia

Question 44

Absent 'a' wave (JVP waves) | Causes

Answer 44

Atrial fibrillation

Question 45

Large 'v' wave (JVP waves) | Causes

Answer 45

Tricuspid regurgitation

Question 46

Absent 'x' descent (JVP waves) | Causes

Answer 46

Tricuspid regurgitation

Question 47

Prominent 'x' descent (JVP waves) | Causes

Answer 47

Constrictive pericarditis

Question 48

Prominent 'y' descent (JVP waves) | Causes

Answer 48

Constrictive pericarditis

Question 49

``` Paradoxical JVP (Kussmaul's sign) (Causes) ```

Answer 49

- Pericardial effusion - Constrictive pericarditis - Pericardial tamponade

Question 50

Amyl nitrate (direct arteriolar vasodilator [increase LV emptying]) (Effects on heart sounds and murmurs) (Maneuver)

Answer 50

- Decreases AR, MR, and VSD murmurs | - Increases AS, MVP and HCOM systolic murmurs