Heart murmurs

Question 1

Diastolic murmurs

Answer 1

Tricuspid stenosis
Mitral stenosis
Pulmonary regurgitation
Ao regurgitation

Question 2

Systolic murmurs

Answer 2

Pulmonary stenosis
Ao stenosis
Tricuspid regurgitation
Mitral regurgitation
VSD

Question 3

Opening snap after S2 that is enhanced with expiration

Answer 3

Mitral stenosis/Tricuspid stenosis

Question 4

Causes of Mitral stenosis

Answer 4

Rheumatic fever (scarring of leaflets)

Question 5

Complications of Mitral stenosis

Answer 5

Pulmonary HTA
Pulmonary congestion
Atrial fibrillation
Compression of left recurrent laryngeal nerve = hoarseness

Question 6

High pitch blowing early diastolic decrescendo murmur after S2.

Answer 6

Ao. regurgitation

Question 7

Characterized by hyperdynamic pulse, head bobbing, and wide pulse pressure

Answer 7

Ao. regurgitation

Question 8

Causes of Ao. regurgitation

Answer 8

Ao. root dilation
Bicuspid Ao. valve
Endocarditis
Rheumatic fever

Question 9

Complication of Ao. regurgitation

Answer 9

Left HF

Question 10

Causes of Ao. root dilation

Answer 10

Syphilis

Marfan Syndrome

Question 11

What is wide pulse pressure?

Answer 11

Normal systole/ high diastole

Question 12

Continuos machine like murmur that runs through S1 to S2 but loudest at S2.

Answer 12

Patent ductus arteriosus

Question 13

Causes of Patent ductus arteriosus

Answer 13

Congenital rubella

Prematurity

Question 14

Best heard at the left infraclavicular region

Answer 14

Patent ductus arteriosus

Question 15

Crescendo-decrescendo systolic ejection murmur with an ejection click, following S1

Answer 15

Ao. stenosis

Question 16

Most common cause of Ao. stenosis in developed countries

Answer 16

Calcific degeneration of trileaflet Ao. valve

Question 17

Most common cause of Ao. stenosis in developing countries

Answer 17

Rheumatic fever

Question 18

Pathophisiology of Rheumatic fever

Answer 18

Fusion of valve comisures due to repetitive inflammation.

Question 19

Pulsus parvus et tardus

Answer 19

Pulses are weak

Question 20

In what murmur can you find Pulsus parvus et tardus

Answer 20

Ao. stenosis

Question 21

Cause in younger patients of Ao. stenosis

Answer 21

Early onset calcification of bicuspid Ao. valve

Question 22

Complications of Ao. stenosis

Answer 22

Syncope
Angina
Dyspnea on exertion

Question 23

Loudest at heart base and radiates to carotids

Answer 23

Ao. stenosis

Question 24

Holosystolic, high pitched “blowing murmur” following S1

Answer 24

Mitral/tricuspid regurgitation

Question 25

Causes of Mitral regurgitation

Answer 25

Ischemic heart disease LV dilation Mitral valve prolapse Rheumatic fever

Question 26

Causes of tricuspid regurgitation

Answer 26

Right ventricular dilation Rheumatic fever Endocarditis (IV drug use)

Question 27

Enhanced by increase in afterload (handgrip or squatting)

Answer 27

Tric/Mitral regurgitation

Question 28

Murmur increases with inspiration

Answer 28

Tricuspid regurgitation

Question 29

Murmur varies with respiration

Answer 29

Pulmonary regurgitation

Question 30

Late systolic crescendo murmur with midsystolic click

Answer 30

Mitral valve prolapse = ballooning of mitral valve into left atrium during systole

Question 31

Causes of Mitral valve prolapse

Answer 31

Myxomatous degeneration Rheumatic fever Chordae rupture

Question 32

What is myxomatous degeneration and causes

Answer 32

1ary or 2ary connective tissue disease such as Marfan or Ehlers Syndrome

Question 33

Most frequent valvular lesion

Answer 33

Mitral valve prolapse

Question 34

Mitral valve prolapse can predispose to?

Answer 34

Infective endocarditis

Question 35

Holosystolic, harsh-sounding murmur. | Loudest at tricuspid area that doesn't radiate.

Answer 35

VSD

Question 36

Crescendo-decrescendo systolic murmur best heard in the 2nd to 3rd IC space close to the sternum

Answer 36

Ao. stenosis

Question 37

Early diastolic decrescendo murmur best heard along the left sternal border with BP of 160/55

Answer 37

Ao. regurgitation

Question 38

Late diastolic decrescendo murmur heard best along the lower left sternal border

Answer 38

Tricuspid stenosis

Question 39

Holosystolic murmur best heard at the apex and often radiates to the left axilla

Answer 39

Mitral regurgitation

Question 40

Late systolic murmur usually preceded by a mid-systolic click

Answer 40

Mitral valve prolapse

Question 41

Crescendo-decrescendo systolic murmur best heard at the 2nd-3rd left interspace close to the sternum

Answer 41

Pulmonary stenosis

Question 42

Rumbling late diastolic murmur with an opening snap, loudest in the 5th interspace in the midclavicular line

Answer 42

Mitral stenosis