Phys exam skills: Murmurs

Question 1

1. Slow rise of the carotid pulse
2. mid to late peak intensity murmur
3. decreased intensity of the 2nd heart sound

Answer 1

dx aortic stenosis

Question 2

1. absence of murmur radiation to the R carotid artery

Answer 2

r/o aortic stenosis

Question 3

Heart murmurs are produced when _____.

Answer 3

turbulent blood flow causes prolonged auditory vibrations of cardiac structures

Question 4

1. max intensity at 2nd R intercostal space

2. radiates to the R carotid artery and R clavicle

Answer 4

typical for aortic stenosis

Question 5

typical findings for aortic stenosis?

Answer 5

1. max intensity at 2nd R intercostal space

2. radiates to the R carotid artery and R clavicle

Question 6

1. max intensity at 5/6th L intercostal space, midclavicular

2. radiates to the L anterior axilla line and L axilla

Answer 6

typical for mitral regurg

Question 7

typical findings for mitral regurg?

Answer 7

1. max intensity at 5/6th L intercostal space, midclavicular

2. radiates to the L anterior axilla line and L axilla

Question 8

1. max intensity at the lower L sternal border

2. radiates to the lower R sternal border, epigastrum, 5th intercostal space- mid L thorax

Answer 8

typical findings for tricuspid regurg

Question 9

typical findings for tricuspid regurg?

Answer 9

1. max intensity at the lower L sternal border

2. radiates to the lower R sternal border, epigastrum, 5th intercostal space- mid L thorax

Question 10

1. max intensity at the 5th L intercostal space, midclavicular
2. radiates to the lower L sternal border

Answer 10

typical for hypertrophic cardiomyopathy

Question 11

typical findings for hypertrophic cardiomyopathy?

Answer 11

1. max intensity at the 5th L intercostal space, midclavicular
2. radiates to the lower L sternal border

Question 12

What is apical-carotid delay? What does it mean?

Answer 12

assess the R carotid pulse and R brachial arterial pulse simultaneously with both hands. Delay btw the 2 = abnormal.

Question 13

What signifies a grade 4 murmur?

Answer 13

a thrill (palpable precordial vibration)

Question 14

How is the 4th heart sound best heard?

Answer 14

using the bell of the stethoscope in the L lateral decubitus position

Question 15

____ are associated with MVP.

Answer 15

Systolic clicks

Question 16

Systolic clicks are associated with ____.

Answer 16

MVP

Question 17

What maneuvers increase the intensity of R sided murmurs? How do they do this?

Answer 17

1. quiet inspiration
2. sustained ab pressure

…. by increasing venous return

Question 18

How are L sided heart murmurs intensified? How do they do this?

Answer 18

place an inflated BP cuff on each arm- murmur should intensify after 20 sec
…. by increasing systemic arterial resistance

Question 19

What maneuvers increase venous return AND systemic arterial resistance?

Answer 19

standing to squatting, passive leg elevation

Question 20

How does the Valsalva maneuver decrease the intensity of aortic stenosis murmurs?

Answer 20

it decreases venous return and increases systemic arterial resistance