Heart Sounds and Murmurs

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What causes the S1 heart sound during the cardiac cycle?

Opening of the tricuspid and mitral valves

Closing of the tricuspid and mitral valves (correct)

Opening of the aortic and pulmonic valves

Closing of the aortic and pulmonic valves

Which valves are closed during diastole?

Aortic and pulmonic valves (correct)

Only the mitral valve

All four valves

Tricuspid and mitral valves

What occurs during systole in the cardiac cycle?

Mitral valve opens

Atria relax

Ventricles contract (correct)

Ventricles fill with blood

Which condition occurs when a valve is supposed to be closed?

Regurgitation Signup and view all the answers

During which phase do the mitral and tricuspid valves open?

Early diastole Signup and view all the answers

What distinguishes stenotic lesions from regurgitant lesions?

Whether the valve fails to open or close properly Signup and view all the answers

Which heart sound results from the closing of the aortic and pulmonic valves?

S2 Signup and view all the answers

During what event in the cardiac cycle do the aortic and pulmonic valves open?

Ventricular contraction Signup and view all the answers

What does the intensity of a heart murmur grade not correlate with?

Disease severity Signup and view all the answers

During which physical activity would you expect to see an increase in intensity of right-sided murmurs?

Inspiration Signup and view all the answers

Which murmur characteristic does not describe its shape?

Loudness Signup and view all the answers

What is the characteristic of a Grade 3 murmur?

Moderately loud Signup and view all the answers

For a heart murmur, which location would NOT typically be associated with an abnormal finding?

3rd Intercostal Space Signup and view all the answers

Which pitch description is NOT commonly used for a heart murmur?

Flat Signup and view all the answers

What type of murmur radiation might be indicative of an aortic stenosis?

Radiation into the carotids Signup and view all the answers

Which maneuver would likely lead to decreased intensity of left-sided murmurs?

Valsalva maneuver Signup and view all the answers

What type of murmur is presented in the 72-year-old male patient?

Crescendo-decrescendo murmur Signup and view all the answers

What is the most likely underlying cause of the murmur in the 72-year-old male patient?

Age-related calcification Signup and view all the answers

Where does the murmur in aortic stenosis typically radiate?

Carotids Signup and view all the answers

What symptom is most closely related to the murmur heard in the 42-year-old Hispanic woman?

Worsening with passive leg raising Signup and view all the answers

What is the most common cause of chest pain in the 72-year-old male patient?

Cardiac ischemia Signup and view all the answers

Which of the following conditions may lead to the symptoms in the 42-year-old woman?

Mitral valve prolapse Signup and view all the answers

Which heart sound might be present in conjunction with the murmur described in the 42-year-old woman?

Midsystolic click Signup and view all the answers

What type of heart murmur is common in patients with a history of untreated strep throat?

Holosystolic murmur Signup and view all the answers

What is the characteristic sound of aortic stenosis?

Crescendo-decrescendo systolic murmur Signup and view all the answers

What effect does an increase in preload have on the murmur associated with aortic stenosis?

Increases intensity Signup and view all the answers

Which symptom is NOT typically associated with aortic stenosis?

Palpitations Signup and view all the answers

What is the classic triad of symptoms seen in patients with severe aortic stenosis?

Syncope, angina, dyspnea on exertion Signup and view all the answers

What physical finding can suggest severe aortic stenosis?

Pulsus parvus et tardus Signup and view all the answers

Which condition is a common underlying cause of aortic stenosis in older patients?

Degenerative calcific changes Signup and view all the answers

How does aortic stenosis affect the splitting of S2 in severe cases?

It leads to paradoxical splitting of S2 Signup and view all the answers

What is a common cause of aortic stenosis in younger patients?

Congenital bicuspid aortic valve Signup and view all the answers

What type of murmur is most likely to be heard with passive leg raising and worsening conditions?

Holosystolic murmur best heard at the apex Signup and view all the answers

Which maneuver is known to worsen most murmurs by increasing preload?

Passive leg raising Signup and view all the answers

Which heart murmur is most likely to be associated with a blowing quality and intensity increasing with handgrip?

Mitral regurgitation Signup and view all the answers

During auscultation, which murmur is characterized as a late systolic murmur with a midsystolic click?

Mitral valve prolapse Signup and view all the answers

What murmur pattern is typically associated with aortic stenosis?

Crescendo-decrescendo Signup and view all the answers

What is the expected change in intensity of tricuspid regurgitation murmur during inspiration?

Increases Signup and view all the answers

What is a characteristic of diastolic murmurs such as aortic regurgitation?

Early decrescendo pattern Signup and view all the answers

Which heart murmur is likely associated with congenital heart conditions and heard near left 2nd ICS?

Pulmonic stenosis Signup and view all the answers

Which murmur is characterized as a rumbling sound following an opening snap?

Mitral stenosis Signup and view all the answers

Which parameter does NOT increase the intensity of aortic stenosis murmur?

Standing Signup and view all the answers

What is typically heard with tricuspid regurgitation due to its relationship to right heart pressures?

Holosystolic sound Signup and view all the answers

What is the typical clinical association of aortic regurgitation?

Widened pulse pressure Signup and view all the answers

Which murmur is most likely to be associated with Ebstein anomaly?

Tricuspid regurgitation Signup and view all the answers

What is a characteristic auscultation finding for mitral regurgitation?

Holosystolic murmur radiating to left axilla Signup and view all the answers

Study Notes

Normal Heart Sounds

The S1 sound is caused by the closing of the mitral and triscupid valves during systole.
The S2 sound is caused by the closing of the aortic and pulmonic valves during diastole.
The cardiac cycle is divided into two phases: systole and diastole.
Systole: ventricles contract, aortic & pulmonic valves open, triscupid & mitral valves close.
Diastole: atria contract, ventricles fill, triscupid & mitral valves open, aortic & pulmonic valves close.

Heart Murmurs

Regurgitation occurs when a valve fails to close when it should during systole or diastole, allowing for backflow of blood.
Stenosis occurs when a valve fails to open completely during systole or diastole, restricting blood flow.

Characteristics of Murmurs

Timing: Systolic murmurs occur during systole, while diastolic murmurs occur during diastole.
Shape: Murmurs can be crescendo, decrescendo, or plateau in intensity.
Location: Murmurs are localized to the 2nd, 4th, or 5th intercostal space (ICS).
Radiation: Murmurs can radiate to other areas, such as the axilla or carotids.
Intensity: Murmurs are graded from I-VI in intensity, with Grade 1 being the faintest and Grade 6 being the loudest.
Quality: Murmurs can be blowing, harsh, rumbling, or musical.
Pitch: Murmurs can be low, medium, or high in pitch.

Dynamic Auscultation

Respiration: Inspiration increases preload on the right ventricle, increasing the intensity of right-sided murmurs, while decreasing the intensity of left-sided murmurs. Expiration often increases the intensity of left-sided murmurs.
Valsalva/Standing: These maneuvers decrease preload.
Rapid Squatting/Leg Raise: These maneuvers increase preload.
Hand Grip: This maneuver increases afterload, worsening left-sided regurgitations.

Aortic Stenosis

Clinical presentation: Crescendo-decrescendo systolic murmur best heard at the right 2nd ICS near the sternal border that radiates to the carotids. This murmur is louder with increased preload.
Severe cases can develop paradoxical splitting of S2.
Clinical signs: syncope, angina, and dyspnea on exertion ("SAD").
Pathophysiology: Most commonly caused by a calcified valve related to age-related degeneration or a congenital bicuspid aortic valve, leading to narrowing of the aortic valve opening.

Pulmonic Stenosis

Clinical presentation: Typically presents with a harsh, crescendo-decrescendo systolic murmur heard in the left 2nd ICS near the sternal border.
Pathophysiology: Often congenital and causes narrowing of the valve between the right ventricle and the pulmonary artery.

Mitral Regurgitation

Clinical presentation: Holosystolic murmur heard at the apex and radiating to the left axilla.
Pathophysiology: Can be caused by mitral valve prolapse, papillary muscle rupture (post-MI), or LV dilation.

Mitral Valve Prolapse

Clinical presentation: Presents with a late crescendo systolic murmur preceded by a midsystolic click heard at the apex.
May lead to mitral regurgitation.
Pathophysiology: Caused by myxomatous degeneration of the mitral valve leaflets.

Tricuspid Regurgitation

Clinical presentation: Holosystolic murmur heard at the left lower sternal border and radiating to the right of the sternum.
Pathophysiology: Often caused by Ebstein anomaly, infective endocarditis in IV drug users, or increased pressure in pulmonary arteries.

Aortic Regurgitation

Clinical presentation: Early decrescendo diastolic murmur heard at the left midsternal border that often radiates to the apex.
Pathophysiology: Commonly caused by congenital bicuspid aortic valve or aortic root dilation.
Clinical signs: Widened pulse pressure, head bobbing, bounding pulse.

Pulmonic Regurgitation

Clinical presentation: Early decrescendo diastolic murmur heard at the left 2nd ICS near the sternal border, radiating along the left sternal border.
Pathophysiology: Typically caused by pulmonary hypertension.

Mitral Stenosis

Clinical presentation: Decrescendo diastolic murmur heard at the apex and often following an opening snap.
Pathophysiology: Commonly caused by chronic rheumatic heart disease.

Tricuspid Stenosis

Clinical presentation: Decrescendo diastolic murmur heard at the left lower sternal border that often follows an opening snap.
Pathophysiology: Relatively rare.

Important Considerations:

Inspiration worsens right-sided murmurs, such as tricuspid regurgitation.
Hand grip worsens left-sided regurgitations, such as mitral regurgitation.
Rapid squatting and leg raise increase preload, worsening most murmurs, except for mitral valve prolapse and hypertrophic obstructive cardiomyopathy (HOCM).
Standing and Valsalva maneuver decrease preload, improving most murmurs.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the characteristics of normal heart sounds and the various types of heart murmurs. Learn about the cardiac cycle, the causes of S1 and S2 sounds, and the implications of regurgitation and stenosis. Test your knowledge of cardiovascular physiology and understand the significance of these heart sounds in clinical practice.