Murmur sounds

Question 1

What murmur is this?

Answer 1

Aortic stenosis
ESM loudest over AV
Crescendo decrescendo
Radiates to carotids
Loudest on expiration when sitting forward
Congenital bicuspid or calcification (or Rh HD)
Slow rising pulse with narrow pulse pressur e
Non-displaced apex
Reduced absent S2 or S2 splitting due to hearing pulmonary valve

Question 2

What murmur is this?

Answer 2

S3

Beginning of diastole just after S2
Lower pitched than S1 S2
Not of valvular origin
Due to oscillation of blood back and forth between walls of ventricle initiated by blood rushing in from the atria
S3 is indicative of increased blood within the ventricle
S3 is ventricular gallop

Question 3

What murmur is this?

Answer 3

MS
Low-pitched rumbling
Mid-diastolic murmur
Loudest over apex
Usually due to Rh HD
Opening click
Loudest in left lateral decubitus on expiration
Low volume pulse (AF common in MS)
Loud first heart sound
Tapping apex
Malar flush

Question 4

What murmur is this?

Answer 4

S4

Low frequency diastolic sounds
Occurs just after atrial contraction
End of diastole and before S1
Blood being forced into a stiff or hypertrophic ventricle e.g. hypertension, AS, cardiomyopathy
S4 is atrial gallop

Question 5

What murmur is this?

Answer 5

AR
Decrescendo
Early diastolic murmur
Loudest left sternal edge
Due to dilatation of aortic root or valve damage like Marfans or IE respectively
Collapsing pulse (water hammer with loud pulse pressure)
Displaced dynamic apex
Eponymous signs:
* Corrigan’s - distension collapse of carotid arteries in neck
* De Musset’s - head bobbing
* Quincke’s - nail bed pulsatioons
* Traube’s - pistol shoot sound over femorals
* Muller’s - uvula pulsations with each heartbeat

Question 6

What murmur is this?

Answer 6

Holosystolic, MR, TR or VSD depending on where it is heart

MR:
Pansystolic
Loudest in mitral area
Radiates to axilla
Loudest on expiration in left lateral decubitus
Displaced, hyperdynamic apex beat

Question 7