Lecture 5: Cardiac Sounds and Murmurs

Question 1

What is the point of maximal impulse?

Answer 1

Location where cardiac impulse can be best palpated on the chest (normally cardiac apex)
-not always palpable

Question 2

Where is the point of maximal impulse found?

Answer 2

5th intercostal space at or just medial to left midclavicular line

Question 3

A large point of maximal impulse can be evidence of what?

Answer 3

Left Ventricular Hypertrophy from hypertension or aortic stenosis

Question 4

What does S1 correspond to?

Answer 4

Turbulence created when the mitral and tricuspid valves close

Question 5

What does S2 correspond to?

Answer 5

Closure of the aortic and pulmonic valves

Question 6

What does S3 correspond to?

Answer 6

Abrupt deceleration of inflow across mitral valve

• produced by the large amount of blood striking a very compliant left ventricle
• sounds like Kent-tuck-y

Question 7

What does S4 correspond to?

Answer 7

Increased stiffness of the left ventricle and decreases compliance
-sounds like ten-nes-see

Question 8

What does systolic heart failure mean?

Answer 8

Lack of proper ventricular contraction

Question 9

What does diastolic heart failure mean?

Answer 9

Lack of proper ventricular relaxation

Question 10

What is wide physiologic splitting of S2?

Answer 10

Increased splitting of S2 during inspiration

-caused by delayed closure of pulmonic valves or early closure of aortic valve

Question 11

What is fixed splitting?

Answer 11

Wide splitting that does not vary with respiration

-prolonged right ventricular systole seen with atrial septal defect

Question 12

What is paradoxical or reversed splitting?

Answer 12

Splitting that appears on expiration and disappears on inspiration

• closure of aortic valve is abnormally delayed
• most commonly due to left bundle branch block

Question 13

What are early systolic ejection sounds?

Answer 13

Occurs shortly after S1 that halt aortic and pulmonic valves open

Question 14

What can cause systolic clicks?

Answer 14

Mitral valve prolapse

Question 15

What causes opening snaps?

Answer 15

Early diastolic sound

-abrupt deceleration during opening of stenotic mitral valve

Question 16

What are systolic murmurs?

Answer 16

Aortic Stenosis and Sclerosis
Innocent Murmur
Hypertrophic Cardiomyopathy 
Ventral Septal Defect
Tricuspid Regurgitation
Mitral Valve Prolapse and Insufficiency

Question 17

What are diastolic murmurs?

Answer 17

Aortic Insufficiency: heard best with bell
Pulmonic Regurgitation
Mitral and Tricuspid Stenosis

Question 18

Describe a grade 1 murmur.

Answer 18

Very faint and might not be heard in all positions

Question 19

Describe a grade 2 murmur.

Answer 19

Quiet but can be heard with stethescope

Question 20

Describe a grade 3 murmur.

Answer 20

Moderately loud, no thrill

Question 21

Describe a grade 4 murmur.

Answer 21

Loud, with palpable thrill

Question 22

Describe a grade 5 murmur.

Answer 22

Very loud, with thrill

-can sometimes be heard when stethoscope is partly off chest

Question 23

Describe a grade 6 murmur.

Answer 23

Very loud with thrill

-can be heard w/o stethoscope

Question 24

Where are systolic murmurs heard?

Answer 24

Between S1 and S2

Question 25

Where are diastolic murmurs heard?

Answer 25

After S2