Lecture 1: Heart Sounds

Question 1

Where is the listening post for the mitral valve?

Answer 1

Left 5th ICS at MCL

Question 2

Where is the listening post for the tricuspid valve?

Answer 2

Left 4th ICS at SB

Question 3

Which grades of murmur are associated with a palpable thrill?

Answer 3

Grade 4-6

Question 4

Which grade of murmur is moderately loud?

Answer 4

Grade 3

Question 5

Which grade of murmur is loud with palpable thrill?

Answer 5

Grade 4

Question 6

What does the S1 and S2 sound signify?

Answer 6

• S1 = closure of the TV and MV
• S2 = closure of the AV and PV

Question 7

Which sound is dull, low pitch; and best heard with the bell?

Answer 7

S2

Question 8

Which heart sound is a ventricular gallop and which is an atrial gallop?

Answer 8

• S3 = ventricular gallop
• S4 = atrial gallop

Question 9

What is the cause of the S4 heart sound?

Answer 9

Forceful ATRIAL contraction against STIFFENED low compliant ventricle

Question 10

What are the systolic murmurs?

Answer 10

MI AS TI PS

Question 11

What are 4 causes of continous murmurs?

Answer 11

• PDA (machinery)
• AV fistula
• ASD with high LA pressure
• Coarctation

Question 12

Most common causes of chronic mitral regurgitation?

Answer 12

• MVP = most common
• MAC (mitral annular calcification)

Question 13

Which cause of systolic murmur is characterized as blowing, prominent at apex; radiates into left axilla?

Answer 13

MR

Question 14

Rumbling, diastolic murmur - low pitched; best heard at apex w/ the bell

Answer 14

Mitral Stenosis

Question 15

What are the hallmark signs/sx’s of aortic stenosis?

Answer 15

• Exertional dyspnea
• Angina
• Syncope
• HF

Question 16

Obstruction caused by aortic stenosis leads to what type of overload?

Answer 16

Pressure overload –> LVH

Question 17

Which systolic murmur is harsh at 2nd ICS RSB; radiates into suprasternal notch/carotids?

Answer 17

Aortic Stenosis

Question 18

Which valvular pathology is associated with narrow pulse pressure; decreased SV and systolic pressure + delayed pulse (parvis/tardus)?

Answer 18

Aortic Stenosis

Question 19

3 major causes of chronic AR?

Answer 19

• Syphilis
• Marfan syndrome
• Ankylosing spondylitis

Question 20

Which valvular pathology is associated with wide pulse pressure?

Answer 20

Aortic Regurgitation

Question 21

3 major causes of acute AR?

Answer 21

• Infective endocarditis
• Aortic dissection
• BAV

Question 22

What is the cause of a diastolic, decrescendo murmur, 3rd ICS LSB?

Answer 22

Aortic Regurgitation

Question 23

Which valvular pathology is a blowing systolic murmur at the 4th ICS LSB; increases with inspiration (Carvallo’s sign)?

Answer 23

Tricuspid Regurgitation

Question 24

Which valvular pathology is associated with a prominent “V” wave in JVP?

Answer 24

Tricuspid Regurgitation

Question 25

Which valvular pathology is a diastolic murmur at the 4th ICS LSP; increases with inspiration (Carvallo’s sign) and decreases with expiration and valsalva?

Answer 25

Tricuspid Stenosis

Question 26

Which valvular pathology has a diastolic, blowing murmur at 2nd ICS LSB?

Answer 26

Pulmonic Regurgitation

Question 27

Which valvular pathology is associated with a Graha Steell murmur?

Answer 27

Tricuspid Regurgitation

Question 28

Which valvular pathology has a systolic murmur w/ ejection click at 2nd-3rd ICS, LSB and radiates toward the left shoulder and increases on inspiration?

Answer 28

Pulmonary Stenosis