murmurs

Question 1

ASD and VSD traits

Answer 1

ASD

• S2 splitting
• systolic murmur at upper LSB

VSD

• holosystolic murmur with thrill at lower LSB
• increases with hand grip

Question 2

S4 heart sound is heard when

Answer 2

atrial fill-in from high pressure from the SVC/IVC and pulmonary venous return
-angina attack can cause an S4 sound
(tenness-ee)

Question 3

traits of HCM

Answer 3

• systolic murmur @ LLSB
• decreases with handgrip and squatting
• S4

Question 4

traits of mitral stenosis

Answer 4

• diastolic murmur, with opening snap
• seen with hx of Rhuematic Fever
• rumbling at apex
• sx: dyspnea, palpitations, a-fib, hoarseness
• USE BELL

Question 5

traits of tricuspid stenosis

Answer 5

• diastolic
• assoc with RF and MS
• prominent A wave (atrial contraction) in jugular vein

Question 6

S1 and S2 sounds correspond to what heart motion

Answer 6

s1- closure of AV valve

s2- closure of the semilunar valve

Question 7

traits of Aortic regurg

Answer 7

-early blowing diastolic murmur
-“AR there she BLOWS!”
-presentation: CT DO, marfans, head-bobbing, water hammer pulse (capillary nail pulsations), femoral bruits
if acute = pulmonary edema; if chronic = dyspnea, orthopnea, angina
tx: decrease after load (vasodilator)

Question 8

what grade murmur do you start to feel a thrill

Answer 8

grade 4 - loud murmur with thrill

Question 9

traits of mitral regurg

Answer 9

-systolic loud blowing (holosystolic) murmur with possible thrill
-radiates to the axilla
-best heard at apex
-assoc with rheumatic dz
-MCC: ischemic papillary M. rupture/dysfucntion, CAD, MI
(seen in CHF after MI)

Question 10

what murmurs increase sound during inspiration ? expiration ?

Answer 10

• RINspiration, *Lexpeiration
• right side (tricuspid and pulmonic ABNL) increase with inspiration
• left side (mitral and Aortic) increase with expiration
• NL if preload (venous return/squatting) or after load (PVR) increase, all murmurs increase
• standing/valsava should decrease sound

Question 11

traits of pulmonic stenosis

Answer 11

systolic crescendo-decresendo

• radiates to left shoulder-clavicle
• assoc with tet of fallot

Question 12

traits of MVP

Answer 12

(chronic mitral regurg)

• mid systolic click; systolic murmur at apex
• common in young women with psychiatric hx
• myoxmatous valvular dz
• increases with handgrip, decreases with squatting

Question 13

what sound may be normal in children, or young athletes, but may indicate CHF or cardiomyopathy in adults

Answer 13

S3 ( ken-tuck-eee)

-AV valves are open to allow filling

Question 14

characteristics of Aortic Stenosis

Answer 14

• systolic cresecendo-decresendo murmur
• Old-SAD (elderly, sx of syncope, angina, dyspnea)
• common in calcified aortic valve (increases with age) or bicuspid aortic valve
• radiates up to the carotids
• weak pulses are common sign

Question 15

traits of pulm regurg

Answer 15

• diastolic decrescendo murmur
• assoc with pulm HTN
• increase S2

Question 16

traits of tricuspid regurg

Answer 16

• holosystolic murmur
• hx of IVDA
• prominent V wave on jugular venous pulse

Question 17

exceptions to rule of thumb with increasing sound of murmurs

Answer 17

MVP and HCM

• MVP and HCM increase sound with valsalva/standing, and decrease sound with squatting (increasing preload)
• MVP increase with handgrip
• HCM decreases with handgrip