Heart Murmurs

Question 1

Continuous machinery murmur, loudest at LUSB

Answer 1

PDA

Question 2

Systolic murmur loudest below left scapula

Answer 2

Coarctation of aorta (seen in Turner’s)

Question 3

Harsh holosystolic murmur at LLSB

Answer 3

VSD

Question 4

Widely split fixed S2 and systolic ejection murmur at LUSB

Answer 4

PFO or ASD

Question 5

“Cooing dove”/high-pitched murmur, diastolic, heard over mid-precordium

Answer 5

Aortic regurgitation

Question 6

Systolic crescendo-decrescendo heard over RUSB with radiation to carotids

Answer 6

Aortic stenosis

Question 7

Systolic crescendo-decrescendo heard over RUSB with systolic ejection click

Answer 7

Calcified aortic stenosis 2/2 bicuspid valve

Question 8

Holosystolic murmur heard best over the apex, radiates to axilla or precordium

Answer 8

Mitral regurgitation

Question 9

Holosystolic murmur heard best over the apex, systolic click

Answer 9

Mitral valve prolapse

Question 10

Valsalva with mitral valve regurgitation

Answer 10

Decreases preload, moves murmur closer to S1, decreases intensity

Question 11

Isometric handgrip with mitral valve regurgitation

Answer 11

Increases afterload, increases intensity of murmur

Question 12

Systolic crescendo-decrescendo murmur heard over LUSB associated with systolic click, radiates to left clavicle

Answer 12

Pulmonary valve stenosis

Question 13

Holosystolic murmur at LLSB, increases with inspiration

Answer 13

Tricuspid valve regurgitation

Question 14

Systolic crescendo-decrescendo murmur at LLSB

Answer 14

Hypertrophic Cardiomyopathy

Question 15

Valsalva in HOCM

Answer 15

Decreases preload => increases intensity of murmur

Question 16

Squatting to standing in HOCM

Answer 16

Decreases preload => increases intensity of murmur

Question 17

Systolic crescendo-decrescendo heard best at RUSB, fixed split S2, RV heave

Answer 17

ASD

Question 18

Diastolic decrescendo murmur at LLSB

Answer 18

Aortic regurgitation

Question 19

Bounding carotid pulse (Corrigan’s pulse) and/or bounding peripheral pulse (Waterhammer’s pulse), widened pulse pressure

Answer 19

Aortic regurgitation

Question 20

Diastolic low-pitched decrescendo murmur heard best at cardiac apex, associated with opening snap

Answer 20

Mitral stenosis

Question 21

Diastolic decrescendo murmur at LLSB, signs of right heart failure

Answer 21

Tricuspid stenosis

Question 22

Diastolic decrescendo murmur at LLSB

Answer 22

Pulmonary regurgitation

Question 23

Carvallo’s maneuver

Answer 23

Inhale => increase in intrathoracic negative pressure => increases capacity of pulmonary circulation => prolongs ejection time => increases Right Heart Murmurs (usually tricuspid regurgitation)

Question 24

Maneuvers to intensify HOCM murmur.

Answer 24

Valsalva => increases intrathoracic pressure => decreases preload => increase in murmur intensity

Question 25

Maneuvers to decrease HOCM murmur

Answer 25

Squatting => increases systemic vascular resistance (and venous return) => increases afterload => helps hold obstruction in place
Maximum handgrip => increases systemic vascular resistance => …