Cardiology - Heart Mumurs

Question 1

Calcifications of the aortic valve in a younger person is caused by

Answer 1

Congenital bicuspid aortic valve

Question 2

Murmur characterized by crescendo-descrescendo with a sharp ejection click

Answer 2

aortic stenosis

Question 3

Systolic mumurs

Answer 3

• pulmonary stenosis
• aortic stenosis
• tricuspid regurgitation
• mitral regurgitation

Question 4

Weak late pulse on palpation found in aortic stenosis

Answer 4

Pulsus parvus et tardus

Question 5

A low amplitude pulse (___) with a slow rising and late peak (____)

Answer 5

parvus
tardus

Question 6

Major symptoms of aortic stenosis

Answer 6

SAD
S - syncope/dizziness
A - angina
D - dyspnea

Question 7

Late systolic ejection murmur that radiates to the carotids and the apex

Answer 7

aortic stenosis

Question 8

Valsalva and standing from squatting decreases or does not change the intensity of this murmur

Answer 8

aortic stenosis

Question 9

Primary test for heart valve disease

Answer 9

TTE (trans-thoracic echocardiogram

Question 10

Second-line modality for confirmation of valvular disease

Answer 10

Trans-esophageal echocardiogram

Question 11

Indications for aortic valve replacement/repair

Answer 11

• symptomatic patients with severe, high-gradient AS
• asymptomatic patients with severe AS + significantly decreased LVEF
• asymptomatic patients with severe AS + undergoing cardiac surgery for another indication
• presence of exertional symptoms

Question 12

Most common valvular heart disease in industrialized countries

Answer 12

Aortic stenosis

Question 13

Common etiologies of aortic stenosis

Answer 13

1. aortic valve sclerosis
2. bicuspid aortic valve
3. rheumatic fever

Question 14

Congenital valvular heart disease characterized by obstruction of blood outflow from the right ventricle to the pulmonary arteries during systole

Answer 14

pulmonary valve stenosis

Question 15

Valvular disease associated with Noonan syndrome

Answer 15

Pulmonary stenosis

Question 16

Systolic murmur heard best over the second left intercostal space

Answer 16

pulmonary stenosis

Question 17

Murmur associated with S2 wide splitting

Answer 17

pulmonary stenosis

Question 18

Valvular disease most commonly caused by rheumatic fever

Answer 18

Mitral stenosis

Question 19

Mauve discoloration of the cheeks due to low cardiac output and systemic vasoconstriction

Answer 19

Mitral facies

Question 20

Diastolic murmur heard best at the 5th left intercostal space at the midclavicular line (apex)

Answer 20

Mitral stenosis

Question 21

Late diastolic low rumbling murmur with an opening snap

Answer 21

Mitral stenosis

Question 22

Diastolic murmur that is enhanced on expiration

Answer 22

Mitral stenosis

Question 23

Murmur that causes dilation of the left atrium

Answer 23

mitral stenosis

Question 24

Murmur that can cause hoarseness and/or dysphagia

Answer 24

mitral stenosis (dilated LA can compress recurrent laryngeal nerve or esophagus

Question 25

Causes of aortic regurgitation

Answer 25

1. infective endocarditis 2. aortic dissection of the ascending aorta 3. chest trauma 4. congenital bicuspid valve 5. rheumatic heart disease 6. connective tissue diseases - Marfans, Ehlers-Danlos 7. chronic HTN 8. tertiary syphilis

Question 26

Most common cause of aortic regurgitation in lower-income countries

Answer 26

rheumatic heart disease

Question 27

Sudden severe dyspnea, rapid cardiac decompensation, pulmonary edema

Answer 27

acute aortic regurgitation

Question 28

Palpitations, left heart failure, high pulse pressure

Answer 28

chronic aortic regurgitation

Question 29

Pulse of peripheral arteries characterized by rapid upstroke and prompt downstroke collapse of the vessels (bounding pulse)

Answer 29

Water hammer pulse

Question 30

Pulse of carotid arteries characterized by rapid upstroke and downstroke (bounding pulse)

Answer 30

Corrigan pulse

Question 31

Rhythmic nodding or bobbing of the head in synchrony with heartbeats found is found in what murmur?

Answer 31

De Musset sign - found in aortic regurgitation

Question 32

High pitched, blowing decrescendo early diastolic murmur

Answer 32

aortic regurgitation

Question 33

Rumbling, low-pitched, mid-diastolic or pre systolic murmur heard best at the apex

Answer 33

Austin Flint murmur

Question 34

Murmur that worsens with hand grip and squatting

Answer 34

Aortic regurgitation

Question 35

Murmur associated with an S3 heart sound

Answer 35

Aortic regurgitation

Question 36

Indications for surgical management of aortic regurgitation

Answer 36

1. acute severe AR 2. symptomatic chronic severe AR 3. asymptomatic chronic severe AR with reduced LVEF < 55%

Question 37

Common etiologies of mitral regurgitation

Answer 37

- mitral valve prolapse (degenerative mitral valve disease) - ruptured chordae tendinae - rheumatic fever - infective endocarditis - papillary muscle rupture following acute MI - CAD

Question 38

Dyspnea, left sided heart failure, pulmonary edema, palpitations, cardiogenic shock

Answer 38

mitral regurgitation

Question 39

High-pitched, blowing holosystolic murmur

Answer 39

Mitral regurgitation

Question 40

Murmur that radiates to the left axilla and is heard best over the apex (5th intercostal space in the left midclavicular line)

Answer 40

mitral regurgitation

Question 41

Increasing preload (leg raise) increases this murmur

Answer 41

mitral regurgitation

Question 42

Increasing afterload (handgrip) increases this murmur

Answer 42

mitral regurgitation

Question 43

Holosystolic mumur that is increased on expiration

Answer 43

Mitral regurgitation

Question 44

What should be ruled out in a patient presenting with acute mitral regurgitation?

Answer 44

Myocardial infarction

Question 45

Echocardiographic sign of left atrial enlargement due to mitral stenosis characterized by a biphasic (double humped) P wave and/or prolongation of the P wave.

Answer 45

P mitrale

Question 46

Holosystolic blowing murmur that radiates to the right sternal border

Answer 46

Tricuspid regurgitation

Question 48

Holosytolic murmur that increases with inspiration

Answer 48

Tricuspid regurgitation

Question 49

A benign finding on auscultation in childhood most likely caused by turbulence in the internal jugular vein; this murmur disappears on compression of the IJV (flexion of the head)

Answer 49

Venous hum