Heart Murmurs

Question 1

Aortic stenosis

Answer 1

Crescendo-decrescendo systolic ejection murmur

*ejection click may be present

Loudest at heart base; radiates to carotids

“Pulsus parvus et tardus”—pulses are weak with a delayed peak

Can lead to Syncope, Angina, and Dyspnea on exertion (SAD)

Question 2

Mitral Regurgitation

Answer 2

Holosystolic, high-pitched “blowing murmur.”

loudest at apex and radiates toward axilla

Rheumatic fever and infective endocarditis can cause either MR or TR

Question 3

Tricuspid Regurgitation

Answer 3

Holosystolic, high-pitched “blowing murmur.”

loudest at tricuspid area and radiates to right sternal border

Rheumatic fever and infective endocarditis can cause either MR or TR

Question 4

Mitral valve prolapse

Answer 4

Late systolic crescendo murmur with *midsystolic click

Most frequent valvular lesion.

Best heard over apex. Loudest
just before S2.

Usually benign.

Can predispose to infective endocarditis.

Can be caused by myxomatous degeneration, rheumatic fever, chordae rupture

Question 5

Ventricular septal defect

Answer 5

Holosystolic, harsh-sounding murmur.

Loudest at tricuspid area

Question 6

Aortic regurgitation

Answer 6

High-pitched “blowing” early diastolic decrescendo murmur

Long diastolic murmur, hyperdynamic pulse, and head bobbing when severe and chronic

Wide pulse pressure

Progresses to left HF

Question 7

Mitral stenosis

Answer 7

Delayed rumbling late diastolic murmur

Follows opening snap (after S2)

Chronic MS can result in LA
dilatation

Question 8

Patent ductus arteriosus

Answer 8

Continuous machine-like murmur

Loudest at S2

Best heard at left infraclavicular area

Often due to congenital rubella
or prematurity