Murmurs

Question 1

Increased Preload

Answer 1

Squatting, leg raises Murmurs get LOUDER, except HOCM and MVP

Question 2

Decreased Preload

Answer 2

Valsalva Murmurs get SOFTER, except HOCM and MVP

Question 3

Increased Afterload

Answer 3

Handgrip Regurgitation murmurs get LOUDER HOCM and MVP gets SOFTER

Question 4

Decreased Preload

Answer 4

Amyl Nitrate HOCM and MVP get LOUDER

Question 5

Aortic Stenosis

Answer 5

Crescendo-Decrescendo (“up the A, down the A”) - louder, softer Presentations: 1. Old - SAD (Syncope, Angina, Dyspnea on exertion) 2. Calcified valve (high calcium levels) Radiates to the carotids

Question 6

Mitral Regurgitation

Answer 6

Holosystolic murmur - doesn’t stop, present for all of systole, the same volume throughout S1—>s2 Hx of rheumatic Fever Radiates to the axilla “Rheu-mitral”

Question 7

Tricuspid Regurgitation

Answer 7

Systolic Holosystolic (there the entire systole) S1—> s2 hx of IV drug abuse (IVDA) “do you want to TRI some drugs”

Question 8

Aortic Regurgitation

Answer 8

Diastolic Early blowing diastolic murmur After S2 head bopping, water hammer pulses (systolic pressure is high, but diastolic pressure is very low bc the blood is flowing back into the heart - strong during systole and collapses during diastole), femoral bruits Presentations: Connective Tissue Disease Marfans “AR you gonna blow me”

Question 9

Mitral Stenosis

Answer 9

Diastolic Opening snap!!! - right after S1 then a short murmur before S2 Hx of Rheumatic Fever “Operating System is MicroSoft - the OS is MS”

Question 10

HOCM

Answer 10

Hypertrophic Obstructive Cardiomyopathy Fam Hx of sudden cardiac death know the manuevers: LOUDER with DECREASED Prelaod and afterload SOFTER with INCREASED Preload and afterload

Question 11

Mitral Valve Prolapse

Answer 11

Mid-systolic click - mid systolic click, between S1 and S2 Presentation: young woman with psychiatric Hx - anxious or depressed Myxomatous Valve Disease “to win MVP, your team has to click”