Heart Sounds/ Murmurs

Question 1

In what murmur can you see head-bobbing, water hammer pulse, or femoral bruits?

Answer 1

aortic regurgitation

Question 2

What characterizes aortic stenosis?

Answer 2

crescendo-decrescendo murmur
btw S1-S2
Old-SAD
radiates UP to carotids

Question 3

What does S3 sound like?

Answer 3

Ken-tuckee
blood filling relaxed and empty ventricle
hear right after S2!

Question 4

What creates the 4th heart sound?

Answer 4

atrial contraction = result of the last little bit of blood being squeezed into the ventricles
normal in children, not generally heard in a normal adult
hear right before S1!

Question 5

What does the LAD/ anterior interventricular A supply blood to?

Answer 5

Part of AV node
part of His bundle
R bundle branch
anterior fascicle of left bundle branch

Question 6

What is the first heart sound?

Answer 6

closure of the AV valve –> blood rushing against it

Question 7

What action decreases aortic stenosis murmors?

increases?

Answer 7

valsalva/standing - decreases

rapid squating - increases

Question 8

What creates the 3rd heart sound?

Answer 8

blood rushing into the ventricle during the rapid filling phase (AV valves open)
*normal in children, but might not be heard in normal adults

Question 9

What is the mnemonic to remember the heart assessment points?

Answer 9

All Physicians Take Money
Aorta = R 2nd intercostal space
Pulmonic area = L 2nd intercostal space
Erb's point = L 3rd intercostal space
Tricuspid = L 4th intercostal space
Mitral = 5th intercostal space, L midclavicular

Question 10

What murmur is associated w/ connective tissue disorders and marfan’s?

Answer 10

aortic regurgitation

Question 11

What causes a systolic murmur?

Answer 11

either blood is moving back into the atria, caused by regurgitation
blood is having a hard time moving in the direction it should be moving in (can’t get into the aorta/pulmonary A

Question 12

What characterizes mitral regurgitation?

Answer 12

“Rheu-mitral”
radiates to axilla
best heard at apex
holosystolic (same loudness throughout) btw S1 and S2

Question 13

What characterizes mitral stenosis?

Answer 13

the Operating System is MicroSoft
opening snap, rheumatic fever hx
loud, soft, then loud before S1

Question 14

What is the second heart sound associated with?

Answer 14

closing of aortic and pulmonary valves –> blood backflows and bounces off closed valves

Question 15

What characterizes a mitral valve prolapse?

Answer 15

midsystolic “click”
associated w/ young women w/ psychiatric history
see the MVP to be the MVP and everything will click

Question 16

What is a heart murmur caused by?

Answer 16

blood moving in a direction it shouldn’t be
or blood having a hard time moving in the direction it should be moving in
can be heard in systole or diastole

Question 17

What are the two exceptions to the general rules of preload?

Answer 17

HOCM and MVP
both: increase in preload improves murmur
and increase in afterload improves murmur

Question 18

What does the Right coronary artery supply blood to?

Answer 18

SA node
AV node
bundle of His
Posterior fascicle of L bundle branch

Question 19

What characterizes a tricuspid regurgitation?

Answer 19

holosystolic btw S1 and S2

Want to TRI some drugs?

Question 20

What characterizes aortic regurgitation?

Answer 20

AR thar she blows!
early blowing after S2
seen in connective tissue disorders, marfan’s
can see head-bobbing, water hammer pulse, and femoral bruits

Question 21

What does S4 sound like?

Answer 21

tennessee = atrial filling from venous return

before S1!

Question 22

What murmurs are associated w/ atrial systole?

Answer 22

tricuspid stenosis

mitral stenosis

Question 23

What are the general rules for what makes murmurs loud or soft?

Answer 23

RINspiration
LEXspiration
increasing preload --> louder murmur
decreasing preload --> softer murmur
increasing afterload --> louder murmur
decreasing afterload --> softer murmur

Question 24

What causes a diastolic murmur?

Answer 24

blood moving back into the aorta or pulmonary artery, caused by regurgitation
blood having a hard time getting into the ventricle due to stenosis

Question 25

How do you grade heart murmors?

Answer 25

score out of 6
1 = soft heart in quiet surroundings
2 = soft heard in noisy surroundings
3 = prominent
4 = loud with a thrill
5 = loud heard w/ edge of steth tilted against chest + thrill
6 = loud heard 5-10 mm from chest + thrill

Question 26

What murmurs are associated w/ ventricular systole?

Answer 26

aortic stenosis

pulmonic stenosis

Question 27

What murmor is associated w/ IV drug use?

Answer 27

tricuspid regurgitation

Question 28

How does inspiration affect heart sounds?

Answer 28

incr intensity of R heart sounds

increases venous return to RA

Question 29

How does hand grip affect heart sounds?

Answer 29

this increases afterload
incr intensity of MR, AR, and VSD murmors
decr hypertrophic cariomyopathy and AS murmurs
MVP: later onset of click/murmur

Question 30

How does valsalva and standing affect heart sounds?

Answer 30

This decreases preload
decr intensity of most murmurs (including AS)
increases intensity of hypertrophic cardiomyopathy murmur
MVP: earlier onset of click/murmur

Question 31

How does rapid squatting affect murmurs?

Answer 31

this increases venous return, preload, and afterload
decr intensity of hypertrophic cardiomyopathy
incr intensity of MR, AR, and VSD
MVP: later onset of click/murmur