Murmur Recap

Question 1

Aortic Stenosis

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 1

1. systolic murmur
2. right upper sternal border, radiating to carotids and apex
3. systolic ejection murmur– when ventricles contract, it has to push the blood through the aorta whole time.
4. mid, harsh
5. parvus et tardus: delayed carotid upstroke (hard to push all the blood out to body, it’ll be slower), apical carotid delay, sustained apex, soft S2, S4 (stiff ventricle– can be due to hypertrophy)

6 causes: degenerative, bicuspid valve instead of tricuspid, rheumatic fever.

Question 2

heart sounds associated with aortic stenossi

Answer 2

systolic murmur at RUSB.

• soft S2: the aorta is stenosed, so it closes softely cause it’s not as forcefull

S4

Question 4

Hypertrophic Obstructive Cardio Myopathy hOCM

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 4

1. systolic murmur
2. LSB and apex– ventricle hypertrophy.
3. systolic ejection murmur, INCREASES WITH VALSALVA and squat to stand.
4. Mid-harsh
5. spike and dome pulse
   - palpable S4 (triple ripple)– ventricular filling – stiff ventricle because of HOCM.
   - MITRAL REGURG MURMUR
6. abnormal beta myosin heavy chain

Question 5

HOCM additional heart sounds

Answer 5

1. palpable triple ripple S4
2. MR mumur. This is because the mitral valve gets stuck to the hypertrophied ventricle, and when the ventricle contracts, the mitral chamber is held open and blood rushes into atrium, causing a mitral regurgitation murmur.

Question 6

a squat to stand action will ___ the murmur in HOCM, ___ the murmur in aortic stenosis, and ___ the mitral valve prolapse murmur

Answer 6

a squat to stand action will INCREASE the murmur in HOCM, DECREASE the murmur in aortic stenosis, and INCREASE the mitral valve prolapse murmur

Question 7

wyy does squat to stand increase a hocm murmur?

Answer 7

• increases murmur in hocm by decreasing venous retrun, decrease preload, preventing the hypertrohpied ventricle from stretching out, thus causing more of an obstruction

Question 8

why would stand to squad decrease a HOCM murmur?

Answer 8

increase LV volume because increases venous return. thus displaces the hypertrophied interventricular septum, causing less outflow obstruction

Question 9

how does a stand to squat action afefct mitral valve prolapse?

Answer 9

it decreases mitral valve prolapse murmur, just like it decreases HOCM. HOCM can cause MR which is kind of like MVP so it ultimately is affected by the same things

Question 10

Pulmonic Stenosis:

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 10

1. systolic murmur
2. Left upper sternal boarder
3. Systolic ejection murmur
4. mid-high
5. RV heave, right sided S4 because the right ventricle is working extra hard to get deoxy blood through the narrow valve. Also may see signs of systemic strain like backflow
6. Shunt issue (especially in peds, like Tetrology of Folet), congenital

Question 11

Mitral regurgitation:

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 11

1. systolic
2. Left border, apex radiating to axilla (going from ventricle to atria to possible pulmonary veins)
3. pansystolic murmur
4. mid
5. low volume pulse (because blood is flowing backward from V–> A instead of to aorta), dilated LV/LA, S3 sound– indicating rapid ventricular filling in diastole– blood doesn’t go through aorta, it goes back to atria which falls back into the ventricle–overall there’s more preload and more end diastolic volume.
6. causes: degenerative, dilated left ventricle, endocarditis, papillary/chordal, HOCM

Question 12

heart changes and heart sound in mitral regurgitation

Answer 12

there is overall an extra volume going to the ventricle and atria because less blood is leaving the heart through the aortic pathway. therefore there may be a dialtion in the LV and LA.

S3 sound also heard– indicates rapid overfilling of blood into ventricle

Question 13

Mitral valve prolapse

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 13

1. systolic murmur
2. left border and apex– might radiate to axilla
3. late systolic crescendo, dynamic!!! increases with valsalva, squat to stand.
4. mid
5. HOCM, dilation of LV or LA, less blood going through aorta so therefore weaker low volume pulse, more blood going to ventricle from atria because it pushed remenants of last cycle into atria, therefore rapid filling S3, SYSTOLIC CLICK
6. congenital

Question 14

what specific heart sounds might you hear in a mitral valve prolapse setting in additin to a systolic late cresecndo murmur

Answer 14

, dilation of LV or LA, less blood going through aorta so therefore weaker low volume pulse, more blood going to ventricle from atria because it pushed remenants of last cycle into atria, therefore rapid filling S3, SYSTOLIC CLICK

Question 15

Tricuspid Regurgitation:

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 15

1. systolic
2. left lower sternal border
3. pansystolic murmur
4. mid
5. RV heave, palpable PULMONARY ARTERY, right sied S3, S4.
6. dilated RV, endocarditis, pulmonary hypertension

Question 17

Ventriculo-septal defect

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 17

1. systolic slosh murmur
2. left sternal border
3. pan systolic murmur past S2
4. mid/harsh
5. palpable pulmonary artery, low volume pulse if large– blood is sloshing around between the two ventricles, not going to the aorta for systemic corculation
6. congenital causes, post MI, traumatic

Question 18

characteristic pulse in aortic regurgitation

Answer 18

watter hammer/corrigans/ super quick upstroke downstroke

Question 19

aortic regurgitation

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 19

1. diastolic murmur
2. left sternal border to apex
3. decrescendo
4. high pitch
5. waterhammer pulse/pulse quick upstroke and quick down stroke, diffuse apex (super enlarged ventricle because all the blood it just pumped into the aorta is trickling back down)
6. causes: degenerative, bicupsid instea of tricuspid, aortic dilation, rheumatic fever/rheumatic heart disease.

Question 20

Pulmonary Regurgitation

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 20

1. diastolic murmur
2. left upper sternal border to lower sternal border
3. decrescendo
4. high
5. palpable pulmonary artery, RV heave, right sided S3 or S4 because of rapid ventricluar filling in diastole
6. congenital (TOF), pulmonary hypertension.

Question 21

Mitral stenosis

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 21

1. diastolic murmur
2. left apex

3. mid-diastolic rumble with pre-systolic increase

4. low pitch
5. LSB impulse– lots of volume in the LA because its just slowly trickling though the stenosed mitral valve to LV. Opening snap, tapping apex. NO s3 or S4– this isn’t a ventriular filling problem as much as it’s an atrial level problem.
6. MAIN CAUSE IS RHEUMATIC!! then degenerative

Question 22

T/F Mitral stenosis causes an S3 or S4

Answer 22

FALSE. it does not cause an S3 or S4. it might cause a diastolic rumble and opening snap followed by LSB impulse.

Question 23

tricuspid stenosis

1. Type of murmur
2. location
3. shape (radiating, crescendo, rumble etc)
4. pitch
5. associated findings (cardiac issues, other heart sounds, pulse changes)
6. causes

Answer 23

1. diastolic murmur
2. LLSB
3. mid diastolic rumble with pre-systolic increase
4. low pitch
5. JVP elevated with slow Y descent
6. congenital, carcinoid.

Question 24

How does tricuspid stenosis affect JVP

Answer 24

JVP gets elevated with slow Y descent

• RA cannot let blood into RV efficiently because of the narrowed tricuspid valve.
• de oxy blood backs up into systemic circulation a bit more– the SVC and JVP get a bit distended– ELEVATES IT-

Question 25

2 murmurs with characteristic mid-diastolic rumble

Answer 25

1. mitral stenosis
2. tricuspid stenosis

both a diastolic murmurs

Question 26

In mitral stenosis, you won’t hear an S3 or S4. Instead, what characteristic findings would be seen?

Answer 26

you’d hear a mid diastolic rumble with an opening snap. Tapping Apex and LSB impulse.

Question 27

Answer 27

Question 28

Answer 28

Question 29

Answer 29

Question 30

Answer 30