Murmurs & Heart Sounds

Question 1

S1

Answer 1

Beginning of systole

Closure of tricuspid and mitral valves (AV valves)

Question 2

S2

Answer 2

Beginning of diastole

Closure of aortic and pulmonary valves

Question 3

Systolic murmurs

Answer 3

In time with carotid pulse

Lub -> murmur -> dub

Question 4

Diastolic murmurs

Answer 4

Lub -> dub -> murmur

Question 5

Systole

which valves are open/closed

Answer 5

Aortic and pulmonary valves open

Tricuspid and mitral valves shut

Question 6

Diastole

which valves are open/closed

Answer 6

Aortic and pulmonary valves closed

Tricuspid and mitral valves open

Question 7

Stenosis

Answer 7

Narrowing of a valve
Valve doesn’t open properly
Valve should be open but it’s narrowed so it’s harder to get contents through

Question 8

Regurgitation

Answer 8

Valve doesn’t close properly
Valve should be closed but it’s open
Back flow of blood

Question 9

Physiological splitting of S2

Answer 9

Occurs during inspiration only

Heard at pulmonary area

Question 10

S3

Answer 10

Physiological or pathological
Physiological - in an other wise healthy child/young adult
Pathological - in an older patient with CVD
Occurs immediately after S2
Best heard at apex with bell

Question 11

S4

Answer 11

Always pathological
Occurs just before S1 (late diastolic)
Stiff ventricle

Question 12

Murmur

Answer 12

Noise

Turbulent blood flow

Question 13

Murmur intensity grading

Answer 13

Grade 1 - disputable
Grade 2-3 - murmur, no thrill
Grade 4-5 - murmur, with thrill
Grade 6 - audible without stethoscope

Question 14

Innocent murmur

Answer 14

Systolic 
Soft 
Caused by increased flow 
Localised to one auscultatory area 
No radiation
May change with patient position 
No other cardiac abnormalities

Question 15

Pathological murmur

Answer 15

Systolic or diastolic
Diastolic murmurs are always pathological 
Not localised to one auscultatory area 
Radiates 
Associated cardiac abnormalities