Murmurs

Question 1

Listen with diaphragm for _____; bell for ______

Answer 1

high-pitched sounds; low-pitched sounds

Question 2

Areas to listen:

Answer 2

1. aortic region (right upper sternal border)
2. pulmonic region (left upper sternal border: 2nd and 3rd intercostal spaces)
3. tricuspid region (left lower sternal border; 4th intercostal space)
4. Mitral region (apex)

Question 3

For high-pitched sounds, have patient; best position to hear gallops is

Answer 3

lean forward;

left lateral decubitus position (left side down) for low-pitched sounds

Question 4

Lub is; dub is

Answer 4

S1 that represents closure of mitral and tricuspid valves, heard loudest at APEX and signals beginning of systole; S2 is closure of aortic and pulmonic valves signalling END of systole and louder at BASE of the heart

Question 5

Gallops are both in

Answer 5

diastole, S4 right before S1; S3 right after S2

Question 6

S3 signifies

Answer 6

increased filling pressure of LV; LV already has elevated filling pressure (low-pitched sound and best heard with bell and at apex, in the LEFT LATERAL DECUBITUS POSITION)

ventricular gallop

Question 7

S4 signifies

Answer 7

ventricle being stiff and noncompliant and the atria contracting to try and fill the ventricle; best heard at apex with bell and do supine position or left lateral decubitus position

atrial gallop

Question 8

Note on gallops

Answer 8

GALLOPS: low pitched sounds, best heard with bell and at apex; S3 is ventricular gallop, and S4 is an atrial gallop, and you WILL NOT HEAR S4 with someone with afib

Question 9

Grading murmurs

Answer 9

a. Grade I - Barely audible
b. Grade II - quiet, intensity similar to S1S2
c. Grade III - Moderately loud
d. Grade IV - loud with a thrill
e. Grade V - very loud, easily palpable thrill
f. Grade VI - audible with stethoscope off chest

Question 10

Mitral regurgitation

Answer 10

systolic murmur
Systolic murmur!!
a.	Best heard at apex
b.	Radiates to back and clavicle
c.	Plateau shaped; can be holosystolic
d.	Increases in intensity with hand grip (isometric exercise)

Question 11

Aortic stenosis

Answer 11

systolic murmur

a. Best heard in aortic region
b. Radiates to the carotids
c. Crescendo/decrescendo in character
d. Intensity decreases with hand grip; increases with squatting

Question 12

Mitral stenosis

Answer 12

diastolic murmur

a. Low intensity rumble
b. Mid-diastolic (extends in duration as stenosis worsens)
c. Heard over apex (better in left lateral position)

Question 13

Aortic regurg:

Answer 13

diastolic murmur

a. Early diastolic
b. Heard best in left 3rd intercostal space
c. Decrescendo in character
d. Increases in intensity with isometric exercises and squatting