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?

<p>Aortic Regurgitation (C)</p> Signup and view all the answers

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

<p>Systolic Click (C)</p> 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?

<p>Aortic Regurgitation (B)</p> 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?

<p>Mitral Valve Prolapse (C)</p> 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?

<p>Pulmonic Stenosis (B)</p> 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?

<p>Aortic stenosis (B)</p> 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?

<p>Mitral stenosis (D)</p> Signup and view all the answers

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

<p>Late systolic (A)</p> 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?

<p>Patent ductus arteriosus (PDA) (B)</p> Signup and view all the answers

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

<p>Crescendo-decrescendo (A)</p> 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?

<p>Mitral regurgitation (C)</p> Signup and view all the answers

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

<p>Systolic ejection murmur of aortic stenosis (C)</p> Signup and view all the answers

Which location is associated with a mid-diastolic murmur?

<p>Apical area (B)</p> 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?

<p>Aortic stenosis (B)</p> 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?

<p>Pulmonary stenosis (A)</p> Signup and view all the answers

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

<p>Grade 4 (A)</p> Signup and view all the answers

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

<p>Pathologic murmur (C)</p> 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?

<p>Functional murmur (A)</p> Signup and view all the answers

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

<p>Mitral regurgitation (D)</p> Signup and view all the answers

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

<p>Patient rolls onto their left side (B)</p> 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?

<p>Pathologic murmur (B)</p> Signup and view all the answers

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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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