Murmurs

Question 1

Jugular venous pressure is equal to

Answer 1

Right atrium pressure

Question 2

What is the difference between the jugular venous pulsations and the carotid impulses?

Answer 2

Jugular pulsations are biphasic

Carotic impulses are monophasics

Question 3

What are the two major upward components of the jugular venous pulsation?

Answer 3

Pressure from right atrium contraction

Passive filling of the right atrium during systole (when tricuspid valve is closed)

Question 4

On the jugular venous pulsation graph, why does the pressure still drops after the tricuspid valves close?

Answer 4

The atrium gets bigger even if the valves are closes, diminishing the pressure

Question 5

By what is produced the first heart sound S1?

Answer 5

By the closure of the mitral and tricuspid valves

Question 6

By what is produced the second heart sound S2?

Answer 6

Closure of the aortic and pulmonary valves

Question 7

What are ejection clicks?

Answer 7

Abnormal sharp high-pitched early systolic sounds coinciding with the opening of the aortic or pulmonary valves

Question 8

Ejection clicks can indicate what (3)?

Answer 8

Congenital aortic stenosis
Pulmonic valve stenosis
Dilatation of the pulmonary artery or aorta

Question 9

Non-ejection clicks can indicate what?

Answer 9

Systolic prolapse of the mitral or tricuspid valves

Often accompanied by valvular regurgitation

Question 10

What are the extra-diastolic heart sounds (4)?

Answer 10

Opening snap
S3
S4
Pericardial knock

Question 11

What is the “opening snap”

Answer 11

Crisp sounds after S2

Corresponds to the opening of the mitral and tricuspid valves (which are normally silent)

Question 12

Opening snap is indicative of what?

Answer 12

Mitral or tricuspid stenosis

Question 13

The S3 sound is indicative of what?

Answer 13

Tensing of the chordea tendineae. Occurs in early diastole during ventricular rapid filling phase.

Question 14

When is S3 sound is normal?

Answer 14

In children and young adults

Question 15

S3 sound is indicative of what is adults?

Answer 15

Dilated ventricle

Question 16

S4 sound coincide with what?

Answer 16

Contraction of the atria

Question 17

Can you hear S4 when there’s atrial fibrillation?

Answer 17

Non. There’s no contraction of the atria

Question 18

What does S4 sound indicate?

Answer 18

Decrease in ventricular compliance (ventricular hypertrophy of myocardial ischemia)

Question 19

By what is generated the S4 sound?

Answer 19

By left atrium ejecting blood in stiffened ventricular

Question 20

By what is produce a murmur?

Answer 20

By turbulent flow

Question 21

A murmur can be caused by five mechanisms. What are they?

Answer 21

Flow across stenosis
Increased flow through normal structures
Ejection in dilated chamber
Regurgitant flow across an incompetent valve (mitral regurgitation)
Abnormal shunting of blood from one vascular chamber to a lower-pressure chamber

Question 22

What is grade 1/6 of murmur intensity?

Answer 22

Barely audible

Question 23

What is grade 3/6 of murmur intensity?

Answer 23

Easily heard

Question 24

What is grade 4/6 of murmur intensity?

Answer 24

Easily heard + thrill

Question 25

What is grade 6/6 of murmur intensity?

Answer 25

Audible without a stethoscope

Question 26

A high-pitch murmur is indicative of what?

Answer 26

Caused by large pressure gradients between chambers

Question 27

Mitral regurgitation murmur radiates where?

Answer 27

Axilla (armpit)

Question 28

What are the three systolic murmurs?

Answer 28

Systolic ejection murmur
Pansystolic/Holosystolic murmur
Late systolic murmur

Question 29

What are the characteristics of systolic ejection murmur?

Answer 29

Between S1 and S2 (during ejection)

Crescendo-decrescendo

Question 30

Systolic ejection murmur is typical of what?

Answer 30

Aortic/pulmonic stenosis

Question 31

What are innocent murmurs?

Answer 31

Same sound as systolic ejection murmur, but disappear when patient sits upright.
Results from increase systolic flow across normal aortic/pulmonic valves

Question 32

Pansystolic/Holosystolic murmur is caused by what (2)?

Answer 32

Regurgitation of blood across incompetent mitral or tricuspid valve
Flow through a ventricular septal defect

Question 33

Why is there no delay between S1 and pansystolic murmur?

Answer 33

Because when ventricular systolic pressure exceeds atrial pressure (S1), there’s immediate retrograde flow across the regurgitant valve (murmur)

Question 34

Does pansystolic murmur of advanced mitral regurgitation continues through aortic closure (S2)?

Answer 34

Yes

Question 35

Does mitral valve regurgitation murmur intensity increase with respiration?

Answer 35

No

Question 36

Does tricuspid valve regurgitation murmur intensity increase with respiration?

Answer 36

Yes

Question 37

Where does tricuspid valve regurgitation murmur radiate?

Answer 37

To the right sternum

Question 38

What is the quality of the murmur of ventricular septal defect

Answer 38

High-pitch, thrill

The smaller the defect, the louder the murmur

Question 39

Late-systolic murmur is a sign of what?

Answer 39

Mitral valve prolapse

Question 40

What are the two types of diastolic murmurs?

Answer 40

Early decrescendo murmur

Mid-to-late rumbling murmur

Question 41

Early decrescendo murmur increases with respiration. It is a sign of what?

Answer 41

Pulmonic regurgitation

Question 42

Early decrescendo murmur is a sign of what (2)?

Answer 42

Pulmonic regurgitation

Aortic regurgitation

Question 43

Mid-to-late rumbling murmur is a sign of what?

Answer 43

Turbulent flow across a stenotic mitral or tricuspid valve

Question 44

Continuous murmur is a result of what?

Answer 44

Persistent pressure gradient between two structures during systole and diastole

Question 45

Continuous murmur can be a sign of which congenital disease?

Answer 45

Patent ductus arteriorus

Question 46

Which murmur is characterized by crescendo-decrescendo-decrescendo (yes yes) and often confused with continuous murmur?

Answer 46

To-and-Fro murmur