Murmurs

Question 1

What are the causes of acute mitral regurgitation?

Answer 1

1. Ischemic papillary muscle dysfunction
2. Ruptured chordae tendinae
3. Infective endocarditis
4. Volume overload increases LA pressure, pul. edema, RVF/LVD, cardiogenic shock

Question 2

What are the causes of chronic mitral regurgitation? What’s the murmur?

Answer 2

MVP most common
MAC, myxomatous or degeneration or MAC

Systolic, blowing at apex, radiates into left axilla. Reduced S1 so use diaphragm

Question 3

What kind of shock does volume overload cause?

Answer 3

Cardiogenic

Question 4

When does the MVP murmur get louder?

Answer 4

Decreased ventricle volume and chamber size

Question 5

This murmur increases on inspiration

Answer 5

Carvallo sign - Tricuspid regurg and tricuspid stenosis

Question 6

Prominent v wave

Answer 6

Triscupid regurg

Question 7

Explain the prognosis of tricuspid regurg

Answer 7

Typically significant only if associated with pulm HTN, lung disease, RV infarction, inferior wall MI, pacemaker

Question 8

The most common etiology of aortic stenosis?

Answer 8

Degenerative calcification

Question 9

ECG shows LVG and strain pattern with downslope of ST segment with T wave

Answer 9

Aortic stenosis

Question 10

When you hear diminished S2 what do you think of?

Answer 10

Aortic stenosis

Question 11

This murmur radiates to your left shoulder/clavicle at 2-3 ICS on L

Answer 11

Pulmonary stenosis

Question 12

This murmur increases with handgrip

Answer 12

VSD and AR and MR

Question 13

Fixed splitting of S2 involved with this murmur

Answer 13

ASD

Question 14

What are the 3 etiologies of mitral stenosis?

Answer 14

1. RHD associated with GAS
2. Congenital
3. MAC

Question 15

This murmur causes hoarseness of voice, DOE, orthopnea, palpitations

Answer 15

Ortners syndrome

Mitral stenosis because LA pressure increases its size

Question 16

Increased S1 and S2 rumbling then opening snap

Answer 16

Mitral stenosis

Question 17

What are the 4 causes of BAV?

Answer 17

1. Aneurysm
2. IE
3. Marfan’s/Turner’s

Question 18

What are the 3 acute causes of Aortic Regurg?

Answer 18

1. Infective endocarditis
2. Aortic dissection
3. Chest trauma

Question 19

What are the 3 chronic causes of aortic regurg?

Answer 19

1. Calcific degeneration
2. BAV
3. Dilated aortic root
4. Rheumatic

BEAR

Question 20

Where is the best place to hear the aortic regurg and hypertrophic cardiomyopathy?

Answer 20

3rd ICS, LSB with soft S2

Question 21

Explain DeMusset’s sign, Quincke’s sign, Traube sign, and Duroziez’s sign?

Answer 21

AR

• DeMusset: head bob with beats
• Quincke’s sign: capillary nail pulsations
• Traube’s sign: pistol shot over femoral artery
• Duroziez’s sign: diastolic murmur over femoral artery when compressed with stethoscope bell

Question 22

ASD best heard where?

Answer 22

2nd ICS L where P is heard

Question 23

VSD best heard where?

Answer 23

4th ICS where Triscupid regurg and Tricuspid stenosis heard

Question 24

Best place to hear pulm. regurg?

Answer 24

2nd ICS LSB associated with pulm. HTN, S2 increased