Heart Murmurs

Question 1

Answer 1

Aortic stenosis
it’s a systolic murmur

Question 2

Holosystolic, high-pitched “blowing” murmur, loudest at apex, radiates toward axilla. Often due to ischemic heart disease, MVP, LV dilatation, rheumatic fever

Answer 2

Mitral regurgitation
it’s a systolic murmur

Question 3

Holosystolic, high-pitched “blowing” murmur, loudest at tricuspid area. Often due to RV dilatation.

Answer 3

Tricuspid regurgitation
it’s a systolic murmur

Question 4

Can MR or TR be caused by infective endocarditis?

Answer 4

both

Question 5

Answer 5

it’s a systolic murmur

Question 6

Answer 6

it’s a systolic murmur

Question 7

Answer 7

It’s a diastolic murmur

Question 8

Answer 8

It’s a diastolic murmur

Question 9

Answer 9

It’s a continuous murmur

Question 10

How does Standing and Valsalva effect murmers

Answer 10

• Cardiovascular changes: decrease preload (decrease LV volume)
• Increase murmur with maneuver: MVP with earlier mid systolic click, HCM
• Decrease murmur with maneuver: Most murmurs (decrease flow through stenotic or regurgitating valve)

Question 11

How does a passive leg raise effect murmurs?

Answer 11

• Cardiovascular changes: increase preload
• Increase murmur with maneuver: most murmurs via increased flow
• Decrease murmur with maneuver: MVP with later mid systolic click, HCM

Question 12

How does squatting effect murmurs?

Answer 12

• Cardiovascular changes: decrease preload (decrease LV volume) and afterload
• Increase murmur with maneuver: MVP with earlier mid systolic click, HCM
• Decrease murmur with maneuver: Most murmurs (decrease flow through stenotic or regurgitating valve)

Question 13

How does hand grip effect murmurs?

Answer 13

• Cardiovascular changes: increase afterload (double up arrow) -> increase reverse flow across aortic valve (increase LV volume)
• Increase murmur with maneuver: Most other left sided murmurs (AR, MR, and VSD)
• Decrease murmur with maneuver: AS (decrease trans-aortic valve pressure gradient) and HCM (increase volume)

Question 14

How does inspiration effect murmurs?

Answer 14

• Cardiovascular changes: increase VR of the right heart, decrease VR of the left heart
• Increase murmur with maneuver: Most right sided murmurs
• Decrease murmur with maneuver: most left sided murmurs