Murmurs

Question 0

Pulmonic area

Answer 0

Pulmonic stenosis
Flow murmurs (ASD, PDA)

Question 1

Aortic area

Answer 1

Aortic stenosis
Flow murmur
Aortic valve sclerosis

Question 2

Left sternal Border

Answer 2

Aortic regurgitation
Pulmonic regurgitation
Hypertrophic cardiomyopathy

Question 3

Tricuspid area

Answer 3

Tricuspid regurgitation
VSD
Tricuspid stenosis
ASD

Question 4

Mitral area

Answer 4

Mitral regurgitation

Mitral stenosis

Question 5

PDA best heard at

Answer 5

Left intraclavicular region

Question 6

Inspiration

Answer 6

Increase right heart sounds

Question 7

Expiration

Answer 7

Increase left heart sounds

Question 8

Left lateral decubitus

Answer 8

S3 sounds

Question 9

Hand grip (increase TPR)

Answer 9

Increase:
MR, AR, VSD, MVP

Decrease:
AS, hypertrophic cardiomyopathy

Question 10

Valsalva (decrease venous return)

Answer 10

Decrease most murmurs

Increase MVP, hypertrophic

Question 11

Rapid squatting

Answer 11

Decrease MVP, hypertrophic

Question 12

Mitral Regurgitation

Answer 12

Holosystolic high pitched blowing murmur
Loudest at apex and radiates to AXILLA
Increase by squatting and expiration 
More severe if S3 present
Can be caused by rheumatic fever and infective endocarditis

Question 13

Tricuspid regurgitation

Answer 13

Holosystolic high pitched blowing murmur
Loudest at tricuspid area and radiates to RIGHT STERNAL border
Increased by inspiration
Can be caused by RV dilation, rheumatic fever, infective endocarditis

Question 14

Aortic stenosis

Answer 14

Crescendo decrescendo systolic ejection murmur following ejection click
LV&raquo_space;» aortic P during systole
Radiated to carotids/ apex
Pulsus parvus et tardus
Syncope, angina, dyspnea
Most due to CALCIFIC aortic stenosis or bicuspid aortic valve

Question 15

VSD

Answer 15

Holosystolic harsh sounding murmur
Loudest at tricuspid
Accentuated with hand grip maneuver to increase afterload

Question 16

Mitral valve prolapse

Answer 16

Late systolic crescendo murmur with mid systolic click
Due to tensing of chordae tendinae
Most frequent valvular lesion
Best heard at apex, loudest at S2
Predisposes to infective endocarditis
Can be caused by myxomatous degeneration, rheumatic fever, chordae rupture
Enhanced by standing or valsalva

Question 17

Aortic regurgitation

Answer 17

Immediate high pitched blowing diastolic decrescendo murmur
WIDE pulse pressure when chronic
Bounding pulses, head bobbing
Due to aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever
Increased by hand grip, vasodilators decrease it

Question 18

Mitral stenosis

Answer 18

Follows opening snap, delayed late diastolic rumbling 
LA>>>LV pressure during diastole
Most due to rheumatic fever
Chronically can result in LA dilation
Enhanced by expiration

Question 19

PDA

Answer 19

Continuous machine like murmur. Loudest at S2
Due to congenital rubella or prematurity
Best heard at left infrclavicular area