murmurs

Question 1

how do we describe murmurs

Answer 1

1. timing (systolic, diastolic, continuous)
2. intensity (grading scale)
3. pitch (/frequency)
4. shape
5. location
6. radiation
7. response to maneuvers

Question 2

how many grades are there for systolic versus diastolic murmur?

Answer 2

systolic can be up to grade VI

diastolic can be up to grade IV

Question 3

what does a low frequency/pitch murmur indicate

Answer 3

LESS pressure gradient between chambers

i.e in mitral stenosis

Question 4

what does a high frequency/pitch murmur indicate

Answer 4

LARGE pressure gradient between chambers

i.e aortic stenosis

Question 5

what shape do ejection murmurs tend to take

Answer 5

crescendo-decrescendo

Question 6

what condition does a systolic ejection murmur indicate

Answer 6

aortic or pulmonic valve stenosis

(normal flow over abnormal valves)

(present in TOF due to severe RVOT stenosis)

Question 7

when does a systolic ejection murmur occur

Answer 7

between S1 and S2 (or during S2)

Question 8

what distinguished the murmur of aortic stenosis versus pulmonic stenosis

Answer 8

audible gap in systolic ejection murmur

the both tend to present with systolic ejection murmurs

Question 9

what conditions tend to present with a pansystolic murmur

Answer 9

caused by REGURGITATION of blood across an incompetent mitral or tricuspid valve, or through a VSD

same intensity throughout systole (holosystolic)–no gap between S1 and the onset of the murmur

Question 10

what condition do late systolic murmur usually indicate

Answer 10

usually mitral valve regurgitation caused by mitral valve prolapse

Question 11

what conditions do early diastolic murmurs tend to indicate

Answer 11

regurgitant flow across aortic or pulmonic valve

if it is aortic regurgitation, it begins at A2 and is a decrescendo until it terminates at next S1

Question 12

what conditions do mid to late diastolic murmurs tend to indicate

Answer 12

either due to turbulent flow over stenotic mitral or tricuspid valve, or abnormally increased flow across a normal valve

if stenosis–> begins after S2, decrescendos until minor crescendo before S1

hyperdynamic states (i.e fever, anemia, hyperthyroidism, exercise) can cause increased flow over normal vales during diastole

L–>R shunt can cause increased flow over normal tricuspid valve due to R sided volume overload (i.e ASD)

advanced MITRAL REGURGITATION can have both the expected systolic murmur, as well as a diastolic murmur as the increased volume flowing LA to LV (from regurgitation) over a stenotic valve causes a diastolic murmur as well

Question 13

what would you suspect if you heard a continuous, machine like murmur at the L subclavicular region

Answer 13

PDA

Question 14

apical murmur with snap, first in pre-systole, progressing to an early diastolic rumble and eventually heard throughout diastole

Answer 14

mitral stenosis

Question 15

mitral regurg mumur?

Answer 15

pansystolic loudest at apex