Heart Sounds: Quick Review, No Sounds

Question 1

CHRONIC Mitral Regurgitation

Answer 1

Holocystolic (Systolic Disease, occurs between S1 and S2)

Accentuated by:
isometric grip
Squatting
Vassopressors

Question 2

Acute Mitral Regurgitation

Answer 2

Early Systolic crescendo-decrescendo

Question 3

Mitral Valve Prolapse

Answer 3

Midsystolic Click /Late Systolic Murmur

Standing- Earlier Click
Squatting – Later Click

Question 4

Tricuspid Regurgitation

Answer 4

Holocystolic

Accentuates: In inspiration

Signs: Carvallo’s Sign (gets louder in inspiration like almost all Right Sided disease) , Pulsative JVD, Pulsatile Liver

Question 5

Ventricular Septal Defect

Answer 5

Harsh Holocystolic

Question 6

Aortic Stenosis

Answer 6

Systolic Crescendo-Decrescendo and may have ejection click early

Accentuated by:
PVC’s (its the post Ectopic beat that causes this)
Squatting
Amyl Nitrite

SIgns
  Radiates to Carotids
  Pulsus Parvus et Tardus
  Paradoxical Splitting 
  Diminished A2

Question 7

HOCM AS

Answer 7

Systolic Crescendo Decrescendo

Accentuated by:
Valsalva
Standing
Amyl Nitrite

Question 8

Pulmonic Stenosis

Answer 8

Systolic Crescendo Decrescendo

Accentuated by:
inspiration (unless click is present)

Question 9

Aortic Insufficiency

Answer 9

Diastolic Decrescendo
High Pitched
Blowing

Signs:
Austin Flint Murmur (though of as a functional mitral stenosis)
Systolic Ejection murmur
Duroziez sign (Systolic murmur over femoral artery when stethoscope is compressed proximally, and a diastolic murmur over femoral artery when stethoscope is compressed distally)

Quinke Pulse (finger nail pulsatile blanching)

Hill Sign(Popliteal systolic blood pressure exceeds brachial systolic blood pressure by >60 mmHg)

Corrigan pulse (Water pump pulse)
Traube Sign (sounds like gun shot at femorals)
Mueller sign (pulsating uvula)

Question 10

Pulmonic Insufficiency

Answer 10

(Graham Steel Murmur)
Early Diastolic
Decrescendo
Loud component of S2

Question 11

Pulmonic insufficiency due to deformity

Answer 11

Mid diastolic
Crescendo Decrescendo
Low Pitched

Question 12

Mitral Stenosis

Answer 12

Mid Diastolic
Holodiastolic if severe
Low Rumble

Due to:
Rheumatic Fever (99%)
Opening snap if early

Question 13

Tricuspid Stenosis

Answer 13

Mid Diastolic
Holodiastolic if severe
Low Rumble

Accentuated on inspiration

Question 14

Patent Ductus Arteriosus

Cervical Venous Hum

Answer 14

Continuous starting after s1 and ending after S2

Question 15

Muffled Heart Sounds

Answer 15

Cardiac Tamponade

Look for Becks Triad:
Hypotension
JVD
Muffled heart Sounds