Pericardial Diseases

Question 1

A wide, fixed splitting of the second heart sound. Large left-to-right shunts can cause a mid-systolic or ejection murmur due to increased pulmonary or tricuspid valve flow.

Early systolic murmur at the left upper sternal border, intensifying with standing and decreasing with sudden standing.

Answer 1

Atrial septal defect (ASD)

Pulmonic stenosis (PS)

Tricuspid stenosis causes a mid-diastolic murmur along the left lower sternal border, increasing with inspiration and leg elevation and decreasing with standing.

Mitral valve prolapse is associated with single or multiple non-ejection clicks and/or mid to late systolic murmurs of mitral regurgitation. Standing or the Valsalva maneuver causes an earlier systolic click and longer murmur due to decreased venous return and left ventricular volume. Squatting or leg elevation causes a delayed systolic click and shorter murmur due to increased left ventricular volume.

Question 2

Bicuspid aortic valve causes a prominent ejection click followed by a mid-systolic murmur, best heard over the right second intercostal space.

Tricuspid stenosis causes a mid-diastolic murmur along the left lower sternal border, increasing with inspiration and leg elevation and decreasing with standing.

Answer 2

Atrial septal defect (ASD)

Pulmonic stenosis (PS)

Question 3

Associated with single or multiple non-ejection clicks and/or mid to late systolic murmurs of mitral regurgitation.

Standing or the Valsalva maneuver causes an earlier systolic click and longer murmur due to decreased venous return and left ventricular volume.

Squatting or leg elevation causes a delayed systolic click and shorter murmur due to increased left ventricular volume.

Answer 3

Mitral Valve Prolapse