Murmurs in Cardiology

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Questions and Answers

A 65-year-old patient presents with a blowing murmur that radiates to the left axilla during systole. What is the most likely classification of this murmur?

Innocent Systolic Murmur

Aortic Stenosis

Mitral Regurgitation (correct)

Mitral Valve Prolapse

What type of murmur is associated with a crescendo-decrescendo intensity pattern?

Aortic Stenosis (correct)

Mitral Stenosis

Pansystolic Murmur

Functional Murmur

A 30-year-old athlete is found to have a normal physiological heart murmur during a sports physical. Which characteristic of this murmur should be expected?

Uniform Intensity (correct)

High Pitch

Pansystolic Configuration

Mid Diastolic Timing

An elderly patient exhibits a high-pitched early diastolic murmur. Which condition is most likely causing this abnormal heart sound?

Aortic Regurgitation Signup and view all the answers

A patient is diagnosed with mitral valve prolapse. Which audible sound would you likely hear during auscultation?

Systolic Click Signup and view all the answers

A murmur is described as decrescendo in intensity after an initial crescendo. What is the likely classification of this murmur?

Aortic Regurgitation Signup and view all the answers

In assessing a patient's heart sounds, a late systolic click is noted. What condition is most likely indicated by this finding?

Mitral Valve Prolapse Signup and view all the answers

A murmur is heard best at the left second intercostal space and is described as a harsh sound. What is the most likely cause of this murmur?

Pulmonic Stenosis Signup and view all the answers

A patient presents with a murmur best heard at the second right intercostal space. Which condition is most likely indicated by this location?

Aortic stenosis Signup and view all the answers

A patient exhibits a late diastolic murmur with a presystolic accentuation. Which of the following is the most likely diagnosis?

Mitral stenosis Signup and view all the answers

The murmur indicating mitral valve prolapse is often described as which of the following?

Late systolic Signup and view all the answers

When evaluating a young adult with a continuous murmur best heard at the second left intercostal space, which condition should be suspected?

Patent ductus arteriosus (PDA) Signup and view all the answers

What is the characteristic acoustic feature of an ejection murmur associated with aortic stenosis?

Crescendo-decrescendo Signup and view all the answers

A heart murmur is identified as a systolic, pansystolic murmur. Which pathology is most likely to cause this murmur?

Mitral regurgitation Signup and view all the answers

Which type of murmur is characterized by a diamond shape on examination?

Systolic ejection murmur of aortic stenosis Signup and view all the answers

Which location is associated with a mid-diastolic murmur?

Apical area Signup and view all the answers

A 60-year-old man presents with a systolic murmur that radiates to his neck. What is the likely diagnosis associated with this type of murmur?

Aortic stenosis Signup and view all the answers

A 45-year-old female patient has a murmur that you can hear best at the left shoulder. What type of murmur does she likely have?

Pulmonary stenosis Signup and view all the answers

What is the grading of a murmur that is easily audible and accompanied by a thrill?

Grade 4 Signup and view all the answers

While examining a patient, you find a loud diastolic murmur that is Grade 5. What does this indicate?

Pathologic murmur Signup and view all the answers

In a patient with a murmur that shows no increase during the Valsalva maneuver, how would you classify this murmur?

Functional murmur Signup and view all the answers

A patient presents with a systolic murmur best heard between the scapulae. What is the most likely situation?

Mitral regurgitation Signup and view all the answers

What maneuver should be performed to best listen for mitral murmurs and S3 heart sounds?

Patient rolls onto their left side Signup and view all the answers

A clinical evaluation reveals a patient with a fixed split second heart sound and a diastolic murmur. What does this suggest?

Pathologic murmur Signup and view all the answers

Study Notes

Murmurs

A sound made by blood flowing through a normal valve or an abnormal valve.
Murmurs are described by:
- Timing
- Loudness (intensity)
- Configuration (shape)
- Frequency (pitch)
- Location
- Radiation
- Response to dynamic maneuvers
Types:
- Systolic:
  - Ejection murmurs: associated with aortic stenosis or pulmonary stenosis
  - Pansystolic (holosystolic): associated with mitral or tricuspid regurgitation
  - Late systolic: associated with mitral valve prolapse
- Diastolic:
  - Early diastolic: associated with aortic regurgitation
  - Diastolic rumble: associated with mitral stenosis
Common Maneuvers:
- Left side position: Bring out S3 and mitral murmurs
- Lean forward position: Bring out aortic murmurs
- Valsalva maneuver:
  - Phase 1: Straining (increased intrathoracic pressure)
  - Phase 2: Release (blood rushes back to heart)

Extrasounds

Systolic Click: associated with innocent/physiologic murmurs, mitral/tricuspid regurgitation, and mitral valve prolapse
Opening Snap: associated with mitral stenosis
Ejection Sound: associated with aortic valve disease
S3: normal in children, associated with heart failure
S4: associated with various diseases

Grading of Murmurs

Grade 1: Just audible
Grade 2: Audible but faint
Grade 3: Readily audible
Grade 4: Easily audible, accompanied by a thrill
Grade 5: Very loud, audible with stethoscope partially off chest
Grade 6: Loud enough to be heard without stethoscope, only need to put ear close to chest

Functional vs Pathological Murmurs

Functional murmurs:
- Common in asymptomatic adults
- Grade I – II @ LSB
- Systolic ejection pattern
- Normal precordium, apex, S1
- Normal intensity & splitting of second sound (S2)
- No other abnormal sounds or murmurs
- No evidence of LVH
Pathologic murmurs:
- Diastolic murmur
- Loud murmur - grade 4 or above
- Regurgitant murmur
- Murmurs associated with a click
- Murmurs associated with other signs or symptoms e.g. cyanosis
- Abnormal 2nd heart sound – fixed split, paradoxical split or single

Additional Tips

JVP inspection: Jugular vein distention
Ejection systolic murmurs:
- Aortic stenosis: Radiates to neck
- Pulmonary stenosis: Radiates to left shoulder
- Mitral regurgitation: Radiates to left axilla and lower left chest at the back

Maneuvers

Valsalva maneuver: A special maneuver used to evaluate the heart, especially for murmurs and extra heart sounds.
Stages:
- Strain phase: Increased intrathoracic pressure
- Release phase: Blood rushes back to the heart
- The maneuver is divided into four phases:

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Description

Explore the intriguing world of murmurs associated with heart valves. This quiz covers their types, characteristics, and how specific maneuvers can reveal different murmurs. Test your knowledge on systolic and diastolic murmurs and their clinical implications.