Murmurs

Question 1

Aortic Stenosis

Answer 1

the murmur is a harsh crescendo-decrescendo
right sternal border
decreases in intensity with the Valsalva maneuver.

Question 2

Tricuspid Regurgitation

Answer 2

early, mid, or late systole
left lower sternal border
decreases with the Valsalva maneuver.

Question 3

Mitral valve prolapse

Answer 3

murmur is heard in mid to late systole, may be clock or honking
left lower sternal border
May move or disappears with the Valsalva maneuver.

Question 4

Refer to Cardiology

Answer 4

Diastolic murmurs
Holosystolic murmurs
Grade 3+ systolic murmurs
Murmur with an extra sound (S3, S4, click)
Murmur that increases when the patient stands

Question 5

Pulmonary Stenosis

Answer 5

Variable intensity
Left intercostal spaces
Increases with valsalva

Question 6

Mitral Regurgitation

Answer 6

Pansystolic blowing
Apex location
No change with valsalve

Question 7

Aortic Regurgitation

Answer 7

Loud blowing, high pitched
upper right sternal border
Increases with valsalva

Question 8

Mitral Stenosis

Answer 8

Low pitched diastolic rumble
Apex or lateral left apex
No changes or slight increase with valsalva

Question 9

Systolic Murmurs

Answer 9

Occurs between S1 and S2
Occurs when a pulse is felt

Question 10

Diastolic Murmur

Answer 10

Occurs between S2 and S1
Occurs when pulse is not felt

Question 11

Diastolic Murmurs

Answer 11

Always pathogenic and indicate heart problem
Always refer

Question 12

Aortic Stenosis Presentation

Answer 12

exertional angina, syncope, and heart failure are the classic signs
Classic crescendo decrescendo midsystolic murmur

Avoid sports, if symptoms severe may refer for surgical repair

Question 13

Aortic Regurgitation Presentation

Answer 13

Initially asymptomatic
Later exertional dyspnea, orthopnea, nocturnal dyspnea, fatigue
LV enlargement is late sign

Signifiant cases need calcium channel blockers, ACEIs, ARBS

Question 14

Mitral Stenosis Presentation

Answer 14

Rhuematic fever is prominent cause
Dyspnea is common symptom, classified on scale of 1-4
Low-pitched rumbling in diastole
Left atrial enlargement may occur

Cardiac refer

Question 15

Mitral Regurgitation Presentation

Answer 15

The patient with MR may remain asymptomatic for decades, but typical symptoms include fatigue due to reduced cardiac output; later in the course of the disease, dyspnea on exertion may occur from LV dysfunction

Harsh pansystolic murmur is classic, and needs referral

Managed with ACEIs, ARBS, Beta blockers

Question 16

Mitral Valve Prolapse Presentation

Answer 16

Most common cause of mitral regurg
May be syndromic (associated with connective tissue diseases) or non-syndromic

Asymptomatic until late, then palpitation, syncope, chest pain, fatigue, anxiety

Irregular heartbeat is common, late systolic murmur that crescendos

Question 17

Murmur Grading Scale

Answer 17

1 - barely audible
2 - Audible but soft
3 - easily audible, same as S1S2
4 - same as S1S2 but palpable thrill
5 - Audible with only rim of stethoscope
6 - audible with stethoscope barely lifted off chest

Question 18

Diastolic Murmurs Mnemonic

Answer 18

ARMS

Aortic Regurg
Mitral Stenosis

Always refer

Question 19

Systolic Murmur Mnemonic

Answer 19

MR Payton Manning AS MVP

Mitral Regurg
Physiological Murmur
Aortic Stenosis
Mitral Valve Prolapse

Question 20

s3

Answer 20

Ken-Tuck-Y

Increased fluid status such as CHF, Pregnancy

Question 21

s4

Answer 21

Ten-es-see

Stiff ventricle
HTN, MI, young athlete