Murmurs

Question 1

Mitral Valve Regurgitation

Answer 1

• Holosystolic, high pitched, blowing murmur
• Loudest at apex and radiates to axilla
• Enhanced by maneuvers that Increase TPR: squat/hand grip or LA return: expiration
• Due to: ischemic heart disease, mitral valve prolapse, or LV dilation

Question 2

Tricuspid valve regurgitation

Answer 2

• Holosystolic, high pitched, blowing murmur
• Loudest at tricuspid area and radiates to RT sternal border
• Enhanced by increasing RA return (Inspiration)
• Due to dilation or endocarditis
  
  • Rheumatic fever can cause both

Question 3

Aortic Stenosis Murmur

Answer 3

• Crescendo-decrescendo systolic ejection mumur
• Follows ejection click due to abrupt halting of valve leaflets
• LV»aortic pressure during systole
• Radiates to carotids/apex
• Pulsus parvus et tardus: pulses weak compared to heart sounds
• Can lead to syncope
• Often due to age-related calcific aortic stenosis or bicuspid aortic valves

Question 4

VSD murmur

Answer 4

• Holosystolic
• Harsh sounding murmur
• Loudest at tricuspid area

Question 5

Mitral prolapse

Answer 5

• Late systolic crescendo murmur
• w/ midsystolic click due to sudden tensing of chordae tendineae
• Most frequent valvular lesion, usually benign
• Loudest at S2
• Can predispose to infective endocarditis
• Can be caused by myxomatous degeneration, rheumatic fever, or chordae rupture
• Enhanced by decreasing venous return: valsalva or standing

Question 6

Aortic Regurgitation

Answer 6

• Immediate high pitched blowing diastolic murmur
• Wide pulse pressure when chronic
• Can present w/ bounding pulses and head bobbing
• Often due to aortic root dilation, bicuspid aortic valve, or rheumatic fever
• vasodilators decreases intensity of murmur

Question 7

Mitral Stenosis

Answer 7

• Follows opening snap due to abrupt halt in leaflet motion in diastole After rapid opening due to fusion at leaflet tips
• Delayed rumbling late diastolic murmur
• LA»LV during diastole
• Often secondary to rheumatic fever
• Chronic MS can lead to LA dilation
• Enhanced by Increased LT atrial return (Expiration)

Question 8

PDA Murmur

Answer 8

-Continuous machine like murmur
-Loudest at S2
Often due to congenital rubella or prematurity