PE Findings

Question 1

Identify the following heart murmur:

Pansystolic murmur heard loudest over the mitral area, radiating to the axilla.

Answer 1

Mitral regurgitation

Question 2

Identify the following heart murmur:

Early diastolic murmur heard loudest at the 3rd intercostal space, left sternal edge (Erb’s point)

Answer 2

Aortic regurgitation

Question 3

Identify the following heart murmur:

Low-pitched, rumbling, mid-diastolic murmur with an opening click heard loudest over the apex

Answer 3

Mitral stenosis

Question 4

Identify the following heart murmur:

Ejection systolic crescendo-decrescendo murmur heard loudest over the aortic valve

Answer 4

Aortic stenosis

Question 5

Identify the following heart murmur:

Pansystolic murmur heard loudest over the 4th intercostal space, left sternal border

Answer 5

Tricuspid regurgitation

Question 6

Which cardiac murmurs are best-heard during the SYSTOLIC phase of the cardiac cycle?

Answer 6

• Mitral regurgitation
• Tricuspid regurgitation
• Aortic stenosis
• Pulmonary stenosis
• Ventricular septal defect
• Mitral valve prolapse (mid-systolic w/opening click)

Question 7

Which cardiac murmurs are best-heard during the DIASTOLIC phase of the cardiac cycle? (distinguish between early and mid-diastolic)

Answer 7

• Aortic regurgitation
• Pulmonary regurgitation
• Mitral stenosis (mid-late diastolic)
• Tricuspid stenosis (mid-late diastolic)

Question 8

What is the pathophysiology behind systolic cardiac murmurs?

Answer 8

Systolic murmurs occur after S1, which is the closing of the atrioventricular valves.

PANSYSTOLIC murmurs are due to a regurgitant valve that leaks blood to a lower-pressure chamber as the ventricles contract (e.g. mitral and tricuspid regurgitation)

MIDSYSTOLIC ejection murmurs are caused by turbulent flow through the stenosed aortic and pulmonary valves (aortic and pulmonary stenosis)

Question 9

What is the pathophysiology behind diastolic cardiac murmurs?

Answer 9

Diastolic murmurs occur after S2, which is the closing of the semilunar (aortic, pulmonary) valves

EARLY DIASTOLIC murmurs have a decrescendo quality and are due to leaky valves (aortic and pulmonary regurgitation)

MID-LATE DIASTOLIC murmurs are due to impaired ventricular filling resulting from stenosed valves (aortic and mitral stenosis)

Question 10

Why are right-sided murmurs louder during inspiration? Which valves does this involve?

Answer 10

Inspiration increases venous return to the right side of the heart

Tricuspid and pulmonic valves

Question 11

Which murmurs are unchanged or softer upon inspiration/ louder on expiration?

Answer 11

Left-sided murmurs

Mitral and aortic valves