MURMURS

Question 1

Crescendo-descrescendo systolic murmur

Answer 1

Aortic Stenosis

Question 2

• Harsh blowing holosystolic murmur

- Midsystolic click

Answer 2

Mitral Regurgitation

Question 3

Diastolic decrescendo murmur

Answer 3

Aortic Regurgitation

Question 4

• Austin Flint murmur (late diastolic rumble)

- Quincke sign

Answer 4

Aortic Regurgitation

Question 5

Aortic Stenosis - causes

Answer 5

• congenital defect

- calcifications (elderly)

Question 6

Machine-like murmur

Answer 6

Patent Ductus Arteriosus

Question 7

Aortic Stenosis - symptom/PE, CXR/ECHO, Tx

Answer 7

• syncope
• CP
• weak pulse/prolonged
• RADIATES TO CAROTIDS (from R sternal border)
• VALSALVA WEAKENS
• dilated aorta
• valve replacement

Question 8

Mitral Regurgitation - causes

Answer 8

• RHD
• MV prolapse
• pap mm dysfxn (MI)

Question 9

Mitral Regurgitation - symptoms/PE, CXR/ECHO, Tx

Answer 9

• palpitations
• orthopnea
• PND
• RADIATES FROM APEX TO AXILLA
• S3

-LA enlargement/LVH

• vd (symptomatic)
• anticoag (afib or emboli hx) –> when atria enlarge = risk of AFIB

Question 10

Aortic Regurgitation - symptoms/PE, CXR/ECHO, Tx

Answer 10

• CP
• orthopnea
• bounding pulses/widened pulse P
• dilated aorta
• LV enlargement
• ACEi, CCB, or nitrates (decr afterload)
• valve replacement

Question 11

Mitral Stenosis - causes

Answer 11

RHD

Question 12

Mitral Stenosis - symptoms/PE, CXR/ECHO, Tx

Answer 12

• DIASTOLIC RUMBLE
• opening snap after S2
• loud S1

-“mid-diastolic rumbling murmur”

Question 13

Tricuspid Regurgitation

Answer 13

• HOLOSYSTOLIC
• RADIATES TO R STERNUM and XIPHOID
• JVP

Question 14

Pulmonic Stenosis

Answer 14

• MIDSYSTOLIC CRESCENDO-DECRESCENDO
• RADIATES TO LEFT SHOULDER and NECK
• early pulmonic ejection sound

Question 15

Diastolic Murmurs

Answer 15

almost always means heart disease

• aortic regurg
• mitral stenosis
• pulm regurg
• tricuspid stenosis

Question 16

DIASTOLIC

Answer 16

~early –> regurg flow through imcompetent valve (aortic MC)

~rumbling = mid/late diastole (sugg stenosis of AV valve (mitral MC))

Question 17

AORTIC REGURG

Answer 17

• soft
• high pitched
• blowing diastolic
• LSB
• sitting, leaning fwd, post exhale

Question 18

MITRAL STENOSIS

Answer 18

• diastolic
• low pitched, decresendo, rumbling
• opening snap at apex

Question 19

PULM REGURG

Answer 19

• high-pitched, descrendo, LSB

- increases with inspiration

Question 20

TRICUSPID STENOSIS

Answer 20

• mid diastolic, rubmbling, LLSB

- opening snap

Question 21

Midsystolic murmurs

Answer 21

• AKA EJECTION MURMURS*
• MC KIND OF MURMUR*
• PATHOLOGICAL, PHYSIOLOGICAL, INNOCENT*
• aortic stenosis
• pulmonic stenosis
• HCOM
• mitral valve prolapse

Question 22

AORTIC STENOSIS

Answer 22

• midsystolic ejection
• crescendo-decrescendo
• RUSB

Question 23

PULMONIC STENOSIS

Answer 23

• hard midsystolic ejection
• crescendo-decrescendo
• widely split S2
• LSB and radiates to left shoulder/neck

Question 24

HCOM

Answer 24

• medium-pitched, midsystolic
• DECREASED w/ squatting and INCREASED with straining
• S4 gallop and apical lift
• stiff left ventricle

Question 25

MITRAL VALVE PROLAPSE

Answer 25

-midsystolic ejection click at apex

Question 26

Pansystolic (holosystolic) murmurs

Answer 26

*pathologic - when blood flows from area of high to low pressure chamber

• mitral regurg
• tricuspid regurg
• ventricular septal defect

Question 27

MITRAL REGURG

Answer 27

• blowing holosystolic murmur at apex

- split S2

Question 28

TRICUSPID REGURG

Answer 28

-high-pitched holosystolic murmur at mid LSB

Question 29

VENTRICULAR SEPTAL DEFECT

Answer 29

• harsh holosystolic murmur
• LSB with wide radiation
• fixed/split S2