Murmurs

Question 1

What is the MCC of mitral stenosis? What does Mitral Stenosis Cause?
how do you treat?

Answer 1

MCC: Scarred from Rheumatic fever
Left atrium pressure increases causing transudation of fluid into the lung interstitium.
Signs of left sided heart failure(Congestive HF): wet lungs.
Manage CHF, replace valve.

Question 2

A pregnant woman who delivers while crashing with a murmur. What is this?

Answer 2

Mitral stenosis

Question 3

What is Aortic Regurge?
The signs?
What is seen on CXR and Echo

Answer 3

Results in volume overloading due to retrograde blood flow into the Left Ventricle and it has to work harder. Do not get good perfusion into the body.
Widened pulse pressure, hypoperfusion (Low BP, poor mentation), dyspnea, chest pain.
On CXR and Echo, see Thick L. Ventricle.

Question 4

What does this describe?

Tall male with chest pain (dissection) and new diastolic murmur?

Answer 4

Aortic Regurge

Question 5

Young person with exercise induced syncope with new murmur, subaortic hypertrophic myopathy underneath. What is the murmur and describe it.
How do you treat it?

Answer 5

Aortic stenosis

Needs hospital and surgery.

Question 6

Middle aged, having heart attack and develops new systolic (and diastolic) loud harsh murmur.
What has happened?
Treatment?

Answer 6

A ruptured valve leaflet or VSD developing after the MI.

Treat for acute heart failure and needs surgeon

Question 7

What is Patent Ductus arteriosus?

Murmur assoc. with it?

Answer 7

In newborn: The right side of the heart that receives oxygen poor blood from the pulmonary arteries is open to the oxygenated blood from left side of heart in the aorta and they mix.
Continuous machine like murmur.

Question 8

What type of murmurs are the worst ones?

Describe these type of murmurs?

Answer 8

Diastolic murmurs.
Either backflow across an outlet valve (pulmonic, aortic) or difficult flow across AV valve (tricuspid, mitral) so cardiac outflow is compromised. Between S2 to S1.

Question 9

What Murmur radiates to the axilla?

Answer 9

Mitral Regurge

Question 10

What is the MC acquired valve d/o in elderly assoced with HTN, hyperlipidemia, smoking?

Answer 10

Aortic Stenosis.

Question 11

What is this valve disorder: systolic ejection murmur that peaks at midsystole heard best at 2nd intercostal area with radiation to the neck and left sternal border?

Answer 11

Aortic Stenosis.

Question 12

What valve disorder has these sxs: dyspnea, chest pain, uncomfortable awareness of heartbeat, widened pulse pressure (between systolic and diastolic), laterally displaced point of maximal impulse.

Answer 12

Aortic regurgitation

Question 13

What condition has a fixed splitting of S2?

Answer 13

Atrial Septal Defect.

Question 14

What is the hallmark sound of prolapse(floppy) of the mitral valve?

Answer 14

Midsystolic click.

Question 15

S1 opening snap: Name the valve disorder?

Answer 15

Mitral Stenosis

Question 16

Murmur that is a diastolic rumble heard best at the left lower sternal margin and xiphoid, augmented during inspiration.

Answer 16

Tricuspid stenosis (right heart failure).

Question 17

Murmur that is low pitched, blowing descrescendo diastolic murmur, heard best at the 3rd intercostal space along the left sternal border.

Answer 17

Aortic regurgitation

Question 18

What murmur is heard best at the Right 2nd ICS with radiation to the neck

Answer 18

Aortic Stenosis.

Question 19

What murmur is heard best at the left lower sternal border?

Answer 19

Tricuspid Regurge.

Question 20

What murmur is heard best at the left 3rd ICS (ERBs point)?

Answer 20

Aortic Regurge.

Question 21

What is the valve disorder most commonly associated with Rheumatic Fever?

Answer 21

Mitral Stenosis

Question 22

What is the apical S4 gallop heart sound?

Causes?

Answer 22

Atrial contraction during presystole that ejects blood into a ventricle which can’t expand further.
Long standing HTN, aortic stenosis, ventricular hypertrophy, hypertrophic cardiomyopathy, early phase of myocardial infarction.

Question 23

What does the Valsalva maneuver cause in the murmur for

Aortic Stenosis and Mitral Regurge?

Answer 23

The Valsalva decreases venous return to the heart, so there is decreased blood return to the L. Ventricle. In AS, murmur gets softer since less blood is being ejected through the aortic valve. In MR, low blood volume goes across the mitral valve so the murmur is softer.

Question 24

What valve disorder has a crescendo-decrescendo heart murmur?

Answer 24

Aortic Stenosis

Question 25

What murmur has little or no radiation?

Answer 25

Mitral stenosis.