Murmurs and Heart Sounds

Question 1

What are 3 innocent murmurs?

Answer 1

Ejection murmurs
Venous hums
Still’s mutmut

Question 2

What are venous hums?

Answer 2

Due to turbulent blood flow in the great veins returning to the heart
Heard as continuous blowing noise heard just below the clavicles

Question 3

What is Still’s murmur?

Answer 3

Low-pitched sound heard at the lower left sternal edge

May be abolished by hyperextension of the back and neck

Question 4

What are characteristics of innocent ejection murmurs?

Answer 4

Soft blowing murmur in the pulmonary area or short buzzing murmur in aortic area
May vary with posture
Localised with no radiation
No diastolic component
No thrill
No added sounds (clicks)
Asymptomatic
No cyanosis
No clubbing
No recessions
No arrhythmias
Normal pulse
No failure to thrive

Question 5

What does a split S2 indicate?

Answer 5

all the time - ASD

normal - double sound in inspiration, single in expiration

Question 6

What does a never split S2 indicate?

Answer 6

TOF
Pulmonary atresia
Severe pulmonary stenosis
Transposition of the great arteries - anterior aorta masks sounds from the posterior pulmonary trunk

Question 7

What does a ejection systolic indicate?

Answer 7

Innocent
or
Peripheral arteiro stenosis

Question 8

What does a pancystolic murmur indicate

Answer 8

VSD
PDA
COA
Mitral incompetence

Question 9

What does a late systolic murmur indicate?

Answer 9

Mitral prolapse, OHCM

Question 10

What does an early diastolic decrescendo indicate?

Answer 10

Aortic or pulmonary incompetence

Question 11

What does a mid-diastolic crescendo-decrescendo indicate?

Answer 11

Increased atria-ventricular valve flow
VSD
ASD
Tricuspid or mitral valve stenosis

Question 12

What does a continuous murmur indicate?

Answer 12

PDA
Venous shunt
AV fistula

Question 13

What are the grades for systolic murmurs?

Answer 13

1 - just audible in quiet room
2 - quiet but easily audible
3 - loud but no thrill
4 - loud with thrill
5 - audible even if the stethoscope only makes partial contact
6 - audible without stethoscope

Question 14

What murmurs are accentuated by inspiration?

Answer 14

Pulmonary stenosis
Tricuspid regurgitation

Inspiration helps systemic venous return

Question 15

What murmurs are accentuated by expiration?

Answer 15

VSD
Mitral incompetence
Aortic stenosis

Augments pulmonary venous return and decreases systemic return

Question 16

What murmurs does the valsava diminish?

Accentuate?

Answer 16

Diminishes systemic venous return and benign flow murmurs

Accentuates murmurs from mitral incompetence and sub-aortic obstruction

Question 17

What does sitting up diminish? Accentuate?

Answer 17

Diminishes innocent flow murmurs

Accentuates murmur from sub aortic obstruction or from a venous hum

Question 18

Features of innocent murmurs

Answer 18

Soft
Systolic
Short
Sounds S1, S2 normal
Symptomless
Special tests normal
Standing/sitting - vary with posture
Sternal depression