Murmurs Organized

Question 1

Valvular stenosis

Answer 1

tightness of valve incr pressure of blood thru valve

Question 2

valvular insufficiency/regurg

Answer 2

leakiness, blood in opposite direction

Question 3

S1

Answer 3

closing of mitral and tricuspid

Question 4

M1 or T1 which is louder

Answer 4

M1 louder because higher pressure in left heart

Question 5

S2

Answer 5

closing of aortic and pulmonic valve

Question 6

A2 or P2 which is louder

Answer 6

A2 louder because higher pressure in left heart

Question 7

Physiologic split S2

Answer 7

A2 occurs before P2 by significant difference due to INSPIRATION (incr venous return to right delays closing of P2)

Question 8

S3

Answer 8

after S2 when passive large amount of blood strikes compliant LV

Question 9

S3 found when

Answer 9

systolic HF due to compliant LV (dilation)

Question 10

S4

Answer 10

before S1 when active atrial contraction forces blood into non-compliant LV

Question 11

S4 found when

Answer 11

diastolic HF from severe LVH causing decr complaince of LV

Question 12

any condition that creates a non-compliant LV (diastolic HF) will produce ___

Answer 12

S4

Question 13

any condition that creates an overly compliant LV (systolic HF)

Answer 13

S3

Question 14

systolic ejection click

Answer 14

bicuspid aortic valve

after S1 - doming of 2 leaflets before opening

Question 15

mitral valve prolapse click

Answer 15

mid-systolic click then high-pitch murmur

due to mitral regurg

Question 16

opening snap

Answer 16

mitral valve leaflets tense and dome into LV in early diastole

mitral stenosis

Question 17

What happens between S1-S2

Answer 17

systole

Question 18

What happens after S2

Answer 18

diastole

Question 19

systole

Answer 19

between S1-S2

Question 20

diastole

Answer 20

after S2

Question 21

Aortic stenosis

describe

Answer 21

diamond mid systolic continuous

Question 22

aortic stenosis

auscult site

Answer 22

2nd RICS

Question 23

aortic stenosis change with respiration

Answer 23

expiration intensify murmur

Question 24

what can distinguish between mild and severe aortic stenosis

Answer 24

mild = peaks early in systole

severe = peaks late in systole

Question 25

pulmonic stenosis | describe

Answer 25

diamond midsystolic high pitch

Question 26

pulmonic stenosis | auscult site

Answer 26

2nd-3rd LICS

Question 27

pulmonic stenosis change with respiration

Answer 27

inspiration intensify murmur

Question 28

what can distinguish between mild and severe pulmonic stenosis

Answer 28

mild = peaks early in systole severe = peaks late in systole

Question 29

Hypertrophic Obstructive cardiomyopathy murmur

Answer 29

midsystole, diamond, high pitch

Question 30

hypertrophic obstructive cardiomyopahty | auscult site

Answer 30

left lower sternal border

Question 31

Mitral regurgitation | describe

Answer 31

holosystolic "blowing" high pitch

Question 32

mitral regurg | auscult site

Answer 32

apex

Question 33

mitral regurg | change with respiration

Answer 33

no change with inspiration separate from tricuspid regurg

Question 34

tricuspid regurg | describe

Answer 34

holosystolic high pitch

Question 35

tricuspid regurg | auscult site

Answer 35

left lower sternal border radiate to right lower sternal border

Question 36

tricuspid regurg change with respiration

Answer 36

increased intensity with inspiration

Question 37

mitral valve prolapse | describe

Answer 37

midsystolic click then high pitch tightening of chordae due to mitral regurg

Question 38

mitral valve prolapse | auscult site

Answer 38

apex

Question 39

aortic regurg | describe

Answer 39

early diastolic, descrendo, high pitch

Question 40

aortic regurg | auscult site

Answer 40

left 3rd ICS

Question 41

aortic regurg | change with disease severity

Answer 41

as aortic regurg worsens, pressure btwn LV and aorta equalize so murmur shorter

Question 42

austin flint murmur

Answer 42

early diastolic rumble at apex due to regurgitant jet against mitral valve

Question 43

mitral stenosis | describe

Answer 43

diastolic descrendo rumble due to turbulence thru stenotic valve opening snap due to high LA pressure

Question 44

mitral stenosis | auscult site

Answer 44

apex

Question 45

tricupsid stenosis

Answer 45

diastolic descrendo rumble due to turbulence thru stenotic valve opening snap due to high RA pressure

Question 46

tricuspid stenosis | auscult site

Answer 46

left 4th iCS, lower sternal border

Question 47

tricuspid stenosis | change with respiration

Answer 47

inspiration incr intensity

Question 48

valsalva hemodynamic changes

Answer 48

decr LV preload

Question 49

valsalva distinguishes what

Answer 49

aortic stenosis from HOCM aortic stenosis soften HOCM loud

Question 50

squatting hemodynamic

Answer 50

return blood from leg to heart | incr LV preload, incr LV filling

Question 51

squatting distinguish what

Answer 51

decr HOCM (displaces outflow obstruction)