Murmurs

Question 1

Ohm’s law of hydrodynamics

Answer 1

Flow equals the change in pressure over resistance

Question 2

Poisseulle-Hagen equation

Answer 2

Flow = deltaP x pi r^4 x viscosity x L

Question 3

Point at which laminar flow becomes turbulent

Answer 3

Reynold’s number = (2 DxVelocityxDensity) over viscosity

Question 4

Reynold’s number where flow becomes highly turbulent

Answer 4

> 3,000

Question 5

Reynold’s number where flow is laminar

Answer 5

<2,000

Question 6

Differentials for systolic murmur heard over the aortic area

Answer 6

Aortic stenosis
Aortic valve sclerosis
Physiologic

Question 7

Differentials for systolic ejection murmur heard over the pulmonic area

Answer 7

Pulmonic stenosis

Question 8

Differentials for diastolic murmur heard over the left sternal border

Answer 8

Aortic regurgitation
Pulmonic regurgitation

Question 9

Differentials for systolic murmur heard over the left sternal border

Answer 9

Hypertrophic cardiomyopathy

Question 10

Differentials for diastolic murmur heard over the tricuspid area

Answer 10

ASD
Tricuspid stenosis

Question 11

Differentials for systolic murmur heard over the tricuspid area

Answer 11

Tricuspid regurgitation
VSD

Question 12

Differentials for holosystolic murmur heard over the mitral area

Answer 12

Mitral regurgitation

Question 13

Differentials for diastolic murmur heard over the mitral area

Answer 13

Mitral stenosis

Question 14

Differentials for systolic murmur heard over the mitral area

Answer 14

Mitral valve prolapse

Question 15

Maneuvers that increase preload/venous return

Answer 15

Squatting
Passive leg raise
Volume administration (IV fluid)

Question 16

Maneuvers that increase afterload

Answer 16

Squatting
Vasopressors
Sustained hand grip
Transient arterial occlusion (BP cuff on both UE)

Question 17

Maneuvers that decrease preload/venous return

Answer 17

Valsalva maneuver
Standing
Rapid standing from squat
Nitroglycerin

Question 18

Maneuver to decrease afterload

Answer 18

Inhaled amyl nitrite

Question 19

Murmurs that increase with increased preload

Answer 19

Aortic stenosis and regurgitation
Mitral stenosis and regurgitation

Question 20

Murmurs that decrease with increased preload

Answer 20

HOCM - hypertrophic obstructive cardiomyopathy
Mitral valve prolapse

Question 21

Murmurs that increase with increased afterload

Answer 21

Mitral regurgitation
Aortic regurgitation

Question 22

Murmurs that decrease with increased preload

Answer 22

Aortic stenosis
HOCM
Mitral valve prolapse

Question 23

Murmurs that increase with decreased preload

Answer 23

HOCM
Mitral valve prolapse

Question 24

Murmurs that decrease with decreased preload

Answer 24

Aortic stenosis and regurgitation
Mitral stenosis and regurgitation

Question 25

Murmurs that decrease with decreased afterload

Answer 25

Mitral regurgitation Aortic regurgitation

Question 26

Murmurs that increase with decreased afterload

Answer 26

Aortic stenosis HOCM Mitral valve prolapse

Question 27

Murmurs that increase with squatting

Answer 27

Mitral regurgitation Aortic regurgitation and stenosis

Question 28

Affect of squatting on murmur of mitral valve prolapse

Answer 28

Delayed click and shortening

Question 29

Murmur decreased by squatting

Answer 29

HOCM Mitral valve prolapse

Question 30

Murmur increased by sustained hand grip

Answer 30

Mitral regurgitation

Question 31

Murmurs decreased by sustained hand grip

Answer 31

HOCM Mitral valve prolapse Aortic stenosis

Question 32

Signs of adequacy of Valsalva maneuver

Answer 32

Neck V distension Increased tone of abdominal wall muscles Flushed face

Question 33

Effect of Valsalva maneuver

Answer 33

Acute increase in intrathoracic and abdominal pressure resulting in decreased venous return to RA

Question 34

Murmurs that are decreased in Valsalva maneuver

Answer 34

Aortic stenosis and regurgitation Mitral stenosis and regurgitation

Question 35

Murmurs that are increase in Valsalva maneuver

Answer 35

HOCM Mitral valve stenosis

Question 36

Murmurs increased after administration of inhaled amyl nitrite

Answer 36

Aortic stenosis HOCM Mitral valve prolapse

Question 37

Affect of inspiration on murmurs

Answer 37

Increased intensity of R sided murmurs

Question 38

Affect of expiration on murmurs

Answer 38

Increased intensity of L sided murmurs

Question 39

Murmur type that is not affected by changes in afterload

Answer 39

Mitral stenosis