Podcast
Questions and Answers
What causes the S1 heart sound during the cardiac cycle?
What causes the S1 heart sound during the cardiac cycle?
Which valves are closed during diastole?
Which valves are closed during diastole?
What occurs during systole in the cardiac cycle?
What occurs during systole in the cardiac cycle?
Which condition occurs when a valve is supposed to be closed?
Which condition occurs when a valve is supposed to be closed?
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During which phase do the mitral and tricuspid valves open?
During which phase do the mitral and tricuspid valves open?
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What distinguishes stenotic lesions from regurgitant lesions?
What distinguishes stenotic lesions from regurgitant lesions?
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Which heart sound results from the closing of the aortic and pulmonic valves?
Which heart sound results from the closing of the aortic and pulmonic valves?
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During what event in the cardiac cycle do the aortic and pulmonic valves open?
During what event in the cardiac cycle do the aortic and pulmonic valves open?
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What does the intensity of a heart murmur grade not correlate with?
What does the intensity of a heart murmur grade not correlate with?
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During which physical activity would you expect to see an increase in intensity of right-sided murmurs?
During which physical activity would you expect to see an increase in intensity of right-sided murmurs?
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Which murmur characteristic does not describe its shape?
Which murmur characteristic does not describe its shape?
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What is the characteristic of a Grade 3 murmur?
What is the characteristic of a Grade 3 murmur?
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For a heart murmur, which location would NOT typically be associated with an abnormal finding?
For a heart murmur, which location would NOT typically be associated with an abnormal finding?
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Which pitch description is NOT commonly used for a heart murmur?
Which pitch description is NOT commonly used for a heart murmur?
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What type of murmur radiation might be indicative of an aortic stenosis?
What type of murmur radiation might be indicative of an aortic stenosis?
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Which maneuver would likely lead to decreased intensity of left-sided murmurs?
Which maneuver would likely lead to decreased intensity of left-sided murmurs?
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What type of murmur is presented in the 72-year-old male patient?
What type of murmur is presented in the 72-year-old male patient?
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What is the most likely underlying cause of the murmur in the 72-year-old male patient?
What is the most likely underlying cause of the murmur in the 72-year-old male patient?
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Where does the murmur in aortic stenosis typically radiate?
Where does the murmur in aortic stenosis typically radiate?
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What symptom is most closely related to the murmur heard in the 42-year-old Hispanic woman?
What symptom is most closely related to the murmur heard in the 42-year-old Hispanic woman?
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What is the most common cause of chest pain in the 72-year-old male patient?
What is the most common cause of chest pain in the 72-year-old male patient?
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Which of the following conditions may lead to the symptoms in the 42-year-old woman?
Which of the following conditions may lead to the symptoms in the 42-year-old woman?
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Which heart sound might be present in conjunction with the murmur described in the 42-year-old woman?
Which heart sound might be present in conjunction with the murmur described in the 42-year-old woman?
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What type of heart murmur is common in patients with a history of untreated strep throat?
What type of heart murmur is common in patients with a history of untreated strep throat?
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What is the characteristic sound of aortic stenosis?
What is the characteristic sound of aortic stenosis?
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What effect does an increase in preload have on the murmur associated with aortic stenosis?
What effect does an increase in preload have on the murmur associated with aortic stenosis?
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Which symptom is NOT typically associated with aortic stenosis?
Which symptom is NOT typically associated with aortic stenosis?
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What is the classic triad of symptoms seen in patients with severe aortic stenosis?
What is the classic triad of symptoms seen in patients with severe aortic stenosis?
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What physical finding can suggest severe aortic stenosis?
What physical finding can suggest severe aortic stenosis?
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Which condition is a common underlying cause of aortic stenosis in older patients?
Which condition is a common underlying cause of aortic stenosis in older patients?
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How does aortic stenosis affect the splitting of S2 in severe cases?
How does aortic stenosis affect the splitting of S2 in severe cases?
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What is a common cause of aortic stenosis in younger patients?
What is a common cause of aortic stenosis in younger patients?
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What type of murmur is most likely to be heard with passive leg raising and worsening conditions?
What type of murmur is most likely to be heard with passive leg raising and worsening conditions?
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Which maneuver is known to worsen most murmurs by increasing preload?
Which maneuver is known to worsen most murmurs by increasing preload?
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Which heart murmur is most likely to be associated with a blowing quality and intensity increasing with handgrip?
Which heart murmur is most likely to be associated with a blowing quality and intensity increasing with handgrip?
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During auscultation, which murmur is characterized as a late systolic murmur with a midsystolic click?
During auscultation, which murmur is characterized as a late systolic murmur with a midsystolic click?
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What murmur pattern is typically associated with aortic stenosis?
What murmur pattern is typically associated with aortic stenosis?
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What is the expected change in intensity of tricuspid regurgitation murmur during inspiration?
What is the expected change in intensity of tricuspid regurgitation murmur during inspiration?
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What is a characteristic of diastolic murmurs such as aortic regurgitation?
What is a characteristic of diastolic murmurs such as aortic regurgitation?
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Which heart murmur is likely associated with congenital heart conditions and heard near left 2nd ICS?
Which heart murmur is likely associated with congenital heart conditions and heard near left 2nd ICS?
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Which murmur is characterized as a rumbling sound following an opening snap?
Which murmur is characterized as a rumbling sound following an opening snap?
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Which parameter does NOT increase the intensity of aortic stenosis murmur?
Which parameter does NOT increase the intensity of aortic stenosis murmur?
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What is typically heard with tricuspid regurgitation due to its relationship to right heart pressures?
What is typically heard with tricuspid regurgitation due to its relationship to right heart pressures?
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What is the typical clinical association of aortic regurgitation?
What is the typical clinical association of aortic regurgitation?
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Which murmur is most likely to be associated with Ebstein anomaly?
Which murmur is most likely to be associated with Ebstein anomaly?
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What is a characteristic auscultation finding for mitral regurgitation?
What is a characteristic auscultation finding for mitral regurgitation?
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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.
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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.
