Murmurs

Question 0

Continuous machine-like murmur
Loudest at S2
Best heard at left infraclavicular area

Answer 0

PDA -often due to congenital rubella

Question 1

Holo systolic
High pitched blowing murmur
Systolic
Loudest at apex and radiates to the axilla

Answer 1

Mitral regurgitation - enhanced by increased systemic resistance and increased return to LA (expiration)

Question 2

What murmurs are enhanced by decreased venous return?

Answer 2

HOCM

MVP

Question 3

What maneuvers decrease venous return?

Answer 3

Valsalva

Standing

Question 4

What maneuvers increase systemic resistance?

Answer 4

Hand grip

Question 5

What murmurs decrease with increased preload?

Answer 5

HOCM

MVP

Question 6

What maneuvers increase preload?

Answer 6

Squatting

Passive leg raise

Question 7

Best heard over apex
Mid systolic click
Late systolic crescendo

Answer 7

MVP - seen in Marian’s, myxomatous change

Question 8

High pitched blowing murmur

Diastolic decrescendo

Answer 8

Aortic regurgitation - enhanced by hand grip

Question 9

What decreases intensity of aortic regurgitation?

Answer 9

Vasodilators

Question 10

What are the buzz words for aortic regurgitation?

Answer 10

Wide pulse pressure
Bounding pulses
Pulsating nails bed
Head bobbing

Question 11

Opening snap

Late diastolic rumble

Answer 11

Mitral stenosis - usually due to chronic RF

Question 12

Crescendo-decrescendo systolic
Ejection click
Radiates to carotids/heart base

Answer 12

Aortic stenosis - caused by age, bicuspid aortic valve

Question 13

What are the sx of aortic stenosis?

Answer 13

Syncope
Angina
Dyspnea in exertion
Paradoxical splitting

Question 14

Holo systolic
Harsh
Loudest at tricuspid area (left eternal border)

Answer 14

VSD

Question 15

Radiates to neck, clavicle, shoulder
Harsh
Heard at left sternal border

Answer 15

Aortic stenosis

Question 16

What are the 2 hold systolic murmurs?

Answer 16

VSD, mitral regurgitation, tricuspid regurgitation

Question 17

What 2 murmurs have decrescendo?

Answer 17

Aortic stenosis and aortic regurgitation

Question 18

Which murmurs have ejection clicks?

Answer 18

MVP and aortic stenosis

Question 19

Radiates to right sternal border
Enhanced by inspiration
Holo systolic high pitched blowing murmur

Answer 19

Tricuspid regurgitation

Question 20

What is a split S2 that does not change with respiration indicate?

Answer 20

Fixed splitting seen in ASD.
This is a left to right shunt that causes increased right atrial and right ventricular volumes therefore causing the pulmonic valve to close later since there is more flowing through it.

Question 21

What is paradoxical splitting?

Answer 21

When the LV doesn’t empty fast enough
Seen in aortic stenosis and left bundle branch block.
Paradoxical because aortic valve closes after the pulmonic which is not normal.