Murmurs

Question 1

: Timing & Duration =
Murmur Classification

Answer 1

Systolic: This type murmur occurs when your heart muscle contracts
Diastolic: This type of murmur occurs when your heart muscle relaxes
Continuous: This type of murmur occurs continuously during both contraction and
relaxation of your heart muscle

Question 2

Murmur Grading Diastolic

Answer 2

Question 3

Murmur Grading Systolic

Answer 3

Question 4

Innocent Murmur​

Answer 4

Innocent flow murmur: Due to abnormally high flow through normal valves. ​

Murmur is in early systole, has a definite start and end point, is crescendo-decrescendo in shape.​

Usually not more than 2/6 intensity​

Young Adults, pregnancy

Question 5

Aortic Stenosis

Answer 5

Murmur is in early systole​

Harsh/grating quality ​

Crescendo-decrescendo shape​

Best heard at right 2nd intercostal space upper sternal borders in patient who is leaning forward with diaphragm of stethoscope​

Radiates to right clavicle and carotids​

Soft murmur when less severe, grows louder as stenosis progresse

Question 6

Mitral Regurgitation (Insufficiency)

Answer 6

Holosystolic​

Blowing​

Heard best at apex with patient in left lateral decubitus position with diaphragm of the stethoscope​

Radiation to axilla and inferior edge of left scapular​

Increase in intensity with squatting​

Decrease in intensity with standing or Valsalva​

Question 7

MITRAL VALVE PROLAPSE

Answer 7

Crisp mid-systolic click​

Best heard on left lateral decubitus position over left apex with diaphragm​

Crescendo-Decrescendo following the click​

Sometimes can be intermittent​

Enhanced and earlier by Valsalva, decreased and later by squatting

Question 8

Ventricular Septal Defect​

Answer 8

Best heard over the “tricuspid area”, or the lower left sternal border, with radiation to the right lower sternal border ​

It is characteristically a holosystolic murmur because the pressure difference between the ventricles is generated almost instantly at the onset of systole, with a left to right shunt continuing throughout ventricular contraction

Question 9

Hypertrophic Cardiomyopathy​

Answer 9

Early peaking harsh diamond shaped systolic murmur​

Heard best at left sternal border​

4th heart sound gallop is also present

Question 10

Aortic Regurgitation (Insufficiency)

Answer 10

Early mid-diastolic flow murmur​

Blowing high pitched​

Decrescendo​

Loudest at 3rd/4th left parasternal intercostal space​

Radiation to neck​

Best heard with patient leaning forward and breath held at end expiration with diaphragm​

Increases with squatting

Question 11

Mitral Stenosis​

Answer 11

Loud S1​

Early diastolic OPENING SNAP
Low pitched​

Decrescendo-crescendo​

Rumbling​

Heard best at the apex with bell at end expiration with patient in left lateral decubitus position​

Increases after Valsalva, squatting​

It is usually described as low-pitched, decrescendo, and rumbling​

Question 12

PULMONIC REGURGITATION INSUFFICIENCY​

Answer 12

High-pitched​

Early diastolic decrescendo​

Left parasternal 4th intercostal space​

Louder with inspiration

Question 13

Friction Rub (NOT A MURMUR)​

Answer 13

Caused by the beating of the heart against an inflamed pericardium or from lung pleura​

Usually continuous and heard diffusely over the chest. ​

It typically has three components, one systolic and two diastolic. The systolic occurs with ventricular contraction, and the diastolic occurs during both rapid ventricular filling and atrial contraction. ​

It is accentuated when the patient sits up and leans forward, and may be accentuated during inspiration.​

If the rub completely disappears when the patient holds his breath it is more likely due to pleural, not pericardial, origin.​