35 Questions
What is the common cause of wide splitting of S2 in patients with primary MR?
Shortening of LV ejection
In patients with severe pulmonary hypertension, which heart sound is louder than A2?
P2
What abnormality in flow rate across the mitral orifice is often associated with an S3?
Abnormal increase in the flow rate
What is the most prominent physical finding in patients with severe MR?
Systolic murmur
What characterizes the holosystolic murmur of chronic MR?
Constant in intensity, blowing, high-pitched
What area does the holosystolic murmur of chronic MR frequently radiate to?
Left axilla and left infrascapular area
What heart condition must the systolic murmur of chronic MR be differentiated from?
AS (aortic stenosis)
What may obscure A2 in patients with severe MR?
Persisting pressure difference between the LV and LA after aortic valve closure
What is often associated with abnormalities of the posterior leaflet in patients with MVP and flail?
Radiation toward the sternum or aortic area
What physical finding may occur in patients with severe MR and an earlier A2 as a consequence of reduced resistance to LV ejection?
Wide splitting of S2
What is the most common cause of wide splitting of S2 in patients with primary MR?
Shortening of LV ejection
In patients with severe pulmonary hypertension, which heart sound is louder than A2?
P2
What physical finding may occur in patients with severe MR and an earlier A2 as a consequence of reduced resistance to LV ejection?
Systolic murmur commencing immediately after the soft S1
What abnormality in flow rate across the mitral orifice is often associated with an S3?
Abnormal increase
What must the systolic murmur of chronic MR be differentiated from?
Aortic stenosis (AS)
What characterizes the holosystolic murmur of chronic MR?
Low-pitched and loudest at the apex
What area does the holosystolic murmur of chronic MR frequently radiate to?
Left axilla
What might obscure A2 in patients with severe MR?
The systolic murmur
What physical finding is often associated with an S3 in patients with an abnormal increase in flow rate across the mitral orifice during the rapid filling phase?
Brief diastolic rumble
What characterizes the holosystolic murmur of chronic MR?
Constant intensity, blowing, and loudest at the apex
What heart condition must the systolic murmur of chronic MR be differentiated from?
Aortic stenosis
In patients with severe pulmonary hypertension, which heart sound is louder than A2?
P2
What causes wide splitting of S2 in patients with primary MR?
Reduced resistance to LV ejection
What may occur with abnormalities of the posterior leaflet in patients with MVP and flail involving this leaflet?
Radiation toward the sternum or aortic area
What is often diminished in patients with primary MR and defective valve leaflets?
S2
What might obscure A2 in patients with severe MR?
Pressure difference between the LV and LA after aortic valve closure
What characterizes the holosystolic murmur of chronic MR?
Constant in intensity and high-pitched
What is often associated with abnormalities of the posterior leaflet in patients with MVP and flail involving this leaflet?
S3 heart sound
What physical finding may occur in patients with severe MR and an earlier A2 as a consequence of reduced resistance to LV ejection?
Wide splitting of S2
In patients with severe pulmonary hypertension, which heart sound is louder than A2?
P2
What abnormality in flow rate across the mitral orifice is often associated with an S3?
Increase in flow rate during the rapid filling phase
What heart condition must the systolic murmur of chronic MR be differentiated from?
Aortic stenosis (AS)
What heart condition must the systolic murmur of chronic MR be differentiated from?
Aortic regurgitation (AR)
What area does the holosystolic murmur of chronic MR frequently radiate to?
The left axilla and left infrascapular area
What is often diminished in patients with primary MR and defective valve leaflets?
S1 heart sound
Study Notes
Mitral Regurgitation (MR)
- Wide splitting of S2 in patients with primary MR is often caused by increased ventricular compliance.
- In patients with severe pulmonary hypertension, P2 is louder than A2.
- An S3 is often associated with an abnormal increase in flow rate across the mitral orifice during the rapid filling phase.
- The most prominent physical finding in patients with severe MR is a holosystolic murmur.
- The holosystolic murmur of chronic MR is characterized by a high-pitched, plateau-like murmur that radiates to the axilla or the back.
- The systolic murmur of chronic MR must be differentiated from the murmur of hypertrophic obstructive cardiomyopathy (HOCM).
- In patients with severe MR, the loud holosystolic murmur may obscure A2.
- Abnormalities of the posterior leaflet in patients with mitral valve prolapse (MVP) and flail may cause an S3.
- In patients with severe MR and an earlier A2, a reduced resistance to LV ejection may occur, leading to a shorter A2.
Mitral Valve Prolapse (MVP)
- Abnormalities of the posterior leaflet in patients with MVP and flail may cause an S3.
- In patients with MVP and flail involving the posterior leaflet, the murmur may occur due to the regurgitation.
Test your knowledge of abnormal heart sounds related to mitral regurgitation, valve leaflet defects, and pulmonary hypertension. Identify the characteristics of S1, S2, A2, and P2 sounds in different cardiac conditions.
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