Heart Murmurs - Cardiovascular - Medbullets Step 1

pulmonic stenosis; flow murmur (e.g., ASD). tricuspid valve. lower left sternal border (LLSB). pansystolic murmur (tricuspid regurgitation ... Cardiovascular ANATOMY&PHYSIOLOGY Hemodynamics High-YieldTopics CoronaryArteryAnatomy CardiacOutputandVariables Resistance,Pressure,andFlow StarlingCurve Cardiac/VascularFunctionCurves CardiacCycle PressureandCirculation MaintenanceofMeanArterialPressure BaroreceptorsandChemoreceptors CirculationthroughOrgans NormalPressures Autoregulation CapillaryFluidExchange CardiacElectrophysiology SpreadofExcitation SANodeActionPotential MyocardialActionPotential CardiacMyocytePhysiology Electrocardiogram(ECG) Ascultation HeartMurmurs Splitting CLINICALCONDITIONS Congenital IntrotoCongenitalHeartDisease TetralogyofFallot TranspositionofGreatVessels AtrialSeptalDefects VentricularSeptalDefects PatentDuctusArteriosus CoarctationoftheAorta OtherCyanoticCongenitalHeartDefects HeartFailure CongestiveHeartFailure Cardiomyopathies EisenmengerSyndrome BloodPressureDisease Hypertension HypertensiveEmergency AorticDisorders AorticDissection SyphiliticHeartDisease AbdominalAorticAneurysm TraumaticAorticDisruption PericardialDisease Pericarditis CardiacTamponade CoronaryArteryDisease(CAD) HyperlipidemiaSigns Arteriosclerosis Atherosclerosis Ischemic Angina MyocardialInfarction SuddenCardiacDeath ValvularDisease ValvularDisease Endocarditis RheumaticHeartDisease EKG Atrioventricular(AV)HeartBlock AtrialArrhythmias VentricularArrhythmias Wolff-Parkinson-White(WPW)Syndrome TorsadesdePointes Tumors CardiacTumors VascularTumors Vasculitides LargeVesselVasculitides MediumVesselVasculitides SmallVesselVasculitideswithImmuneComplexes SmallVesselVasculitideswithoutImmuneComplexes BehcetSyndrome HereditaryHemorrhagicTelangiectasia(Osler-Weber-RenduSyndrome) VaricoseVeins Thrombophlebitis PHARMACOLOGY PHARMACOLOGY SitesofActionforCardiacDrugs AntihypertensiveTherapy AntianginalTherapy Direct-ActingVasodilators LipidLoweringDrugs CardiacGlycosides(Digoxin) Antiarrhythmics Updated:10/1/2021 25 HeartMurmurs DamianApolloMD 0 0% Topic ReviewTopic 0 0 0 N/A N/A Questions 13 0 0 0 0% 0% Evidence 14 0 0 0 0% 0% Videos/Pods 9 AuscultationRulesofThumb "AllPhysiciansTakeMoney"(ruleofthumb/mnemonic)  aorticvalve upperrightsternalborder aorticstenosis flowmurmur aorticvalvesclerosis leftventricularoutflowtractobstruction lateraldisplacementofmaximalimpulse S4gallop upperleftsternalborder(ULSB)harsh,crescendo-decrescendosystolicmurmur hypertrophicobstructivecardiomyopathy pulmonicvalve ULSB pulmonicstenosis flowmurmur(e.g.,ASD) tricuspidvalve lowerleftsternalborder(LLSB) pansystolicmurmur(tricuspidregurgitationandVSD) diastolicmurmur(tricuspidstenosisandASD) mitralvalve apex  systolicmurmur(mitralregurgitation)  diastolicmurmur(mitralstenosis)  MurmurCheatSheet Crescendo/Decrescendo Holosystolic Systolic AS(toneck) MVP(click) HOCM MR(toaxilla) TR(inspirationincreases) VSD(harsh) Diastolic Aorticregurgitation MS(openingsnap) NOTE:Seechartbelowforabbreviations MurmurIdentification   Lesion Shape LocationHeard Alteredby Characteristics Systolic Aorticstenosis(AS) Crescendo-decrescendo Radiatestoneck(carotids)andapex  -- "Parvusettardus"(pulsesweakcomparedtoheartsounds) Followsejectionclick(duetohaltingofvalveleaflets)   Hypertrophiccardiomyopathy(HOCM) Crescendo-decrescendo -- ↓venousreturn(e.g.,Valsalva)-increasesmurmur -- Mitralvalveprolapse(MVP)  Latecrescendo -- ↑TPR(e.g.,squatting,handgrip)-decreasesmurmur ↓venousreturn(e.g.,Valsalva)-increasesmurmur Mid-systolicclick(tensingofchordaetendinae) LoudestatS2 Laterwith ↑afterload(e.g.,handgrip). Mitralregurgitation(MR)  Holosystolic Radiatestoaxilla ↑TPR(e.g.,squatting,handgrip) ↑LAreturn(e.g.,expiration)   High-pitched,blowing Tricuspidregurgitation(TR)  Holosystolic Radiatestorightsternalborder ↑RAreturn(e.g.,inspiration) High-pitched,blowing Ventricularseptaldefect(VSD)  Holosystolic -- -- Harsh-sounding Diastolic Aorticregurgitation(AR) Earlydecrescendo Leftsternalborderwithpatientleaningforward -- High-pitchedblowingheardatendofexpiration Mitralstenosis(MS) Laterumble  Heardinlateralleftdecubitusposition ↑LAreturn(e.g.,expiration) Opening snap (tensingofchordaetendinae)inearlydiastoleafterA2 Other Patentductusarteriosus(PDA) Continuous ULSB -- Machine-like,continuous/constantmurmurheardthroughsystoleanddiastole Atrialseptaldefect(ASD) Systolicanddiastolic Systolic:ULSB(pulmonicvalve) Diastolic:LLSB(tricuspidvalve) -- -- Pleaseratetopic. Average4.5of25Ratings Sorry,thisquestionisfor PEAKPremiumSubscribersonly UpgradetoPEAK Sorry,thisquestionisfor PEAKPremiumSubscribersonly UpgradetoPEAK Sorry,thisquestionisfor PEAKPremiumSubscribersonly UpgradetoPEAK (M1.CV.15.75) A65-year-oldmalewithahistoryofcoronaryarterydiseaseandmyocardialinfarctionstatuspostcoronaryarterybypassgraft(CABG)surgerypresentstohiscardiologistforaroutineappointment.Onphysicalexam,thecardiologistappreciatesaholosystolic,high-pitchedblowingmurmurheardloudestattheapexandradiatingtowardstheaxilla.Whichofthefollowingisthebestpredictoroftheseverityofthispatient'smurmur? QID: 106799 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Enhancementwithhandgripmaneuver 24% (60/248) 2 Enhancementwithexpiration 8% (21/248) 3 PresenceofaudibleS3 48% (118/248) 4 Enhancementwithinspiration 9% (22/248) 5 PresenceofaudibleS4 8% (20/248) M2 QuestionComplexity E QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 3 ReviewTestedConcept ReviewFullTopic Sorry,thisquestionisfor PEAKPremiumSubscribersonly UpgradetoPEAK Sorry,thisquestionisfor PEAKPremiumSubscribersonly UpgradetoPEAK (M1.CV.14.141) A73-year-oldmanpresentstoyourclinicforaroutinecheckup.Hismedicalhistoryisnotableforapreviousmyocardialinfarction.Hestatesthathehasnotseenadoctorin"manyyears".Hehasnocomplaints.Whenyouauscultateoverthecardiacapexwiththebellofyourstethoscope,younoticeanadditionalsoundimmediatelyprecedingS1.Thisextraheartsoundismostlikelyindicativeofwhichofthefollowingprocesses? QID: 100657 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Increasedleftventricularcompliance 4% (7/166) 2 Decreasedleftventricularcompliance 75% (124/166) 3 Increasedleftventricularfillingvolume 10% (17/166) 4 Decreasedleftventricularfillingvolume 8% (13/166) 5 Increasedpulmonarycompliance 1% (1/166) M1 QuestionComplexity D QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 2 ReviewTestedConcept ReviewFullTopic (M1.CV.13.130) A79-year-oldmanpresentstotheemergencyroomafterasyncopalevent.Thepatienthasahistoryofhyperlipidemiaforwhichheistakingatorvastatin.Onphysicalexamination,hisvitalsignsarestable,butoncardiacauscultation,youdetectacrescendo-decrescendosystolicmurmurloudestontherightuppersternalborderradiatingtotheneck.Onphysicalexam,onewouldalsoexpect: QID: 100646 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Thatthemurmurwouldbestbeheardinthelateralleftdecubitusposition 4% (4/104) 2 Thecharacterofthemurmurwouldbemachine-like 4% (4/104) 3 Themurmurwouldalsohaveamid-systolicclickloudestbeforeS2 10% (10/104) 4 Themurmurwouldalsohaveanopeningsnap 10% (10/104) 5 Palpationofthecarotidpulsewouldbeweakandlaterelativetothepatient’sheartsounds 72% (75/104) M2 QuestionComplexity E QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 5 ReviewTestedConcept ReviewFullTopic (M1.CV.13.26) A65-year-oldmalepresentstohiscardiologisttodiscussincreasingepisodesofdyspneaafterclimbingstairs.Healsonowneedsthreepillowsatnighttosleep.Physicalexaminationrevealsanearlydiastolicmurmurbestappreciatedattheleftsternalborderwithboundingperipheralpulses.Thecardiologistisveryconcernedandimmediatelyrefersthepatientforasurgicalworkup.Whatisthemostlikelydiagnosis? QID: 100542 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Mitralvalveinsufficiency 5% (16/324) 2 Aorticregurgitation 72% (234/324) 3 Mitralstenosis 13% (41/324) 4 Aorticstenosis 6% (19/324) 5 Atrialmyxoma 2% (7/324) M2 QuestionComplexity E QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 2 ReviewTestedConcept ReviewFullTopic (M1.CV.13.121) A33-year-oldHonduranwomanpresentstoyourclinicwithshortnessofbreath.Shereportsthathersymptomshaveprogressedoverthepastseveralmonthsandarenowimpactingherqualityoflifebecauseshecannotcompleteherusualexerciseroutine.Sherecalls"normal"childhoodillnesses,includingsorethroatsandfevers,butneverrequiredhospitalization.Vitalsignsaretemperature37degreesCelsius,bloodpressure110/70mmHg,heartrate109/min,respiratoryrate22/min,andoxygensaturation98%onroomair.Physicalexamrevealsaholosystolic,high-pitched,blowingmurmuratthecardiacapex.Onewouldexpectthatthismurmurwouldalso: QID: 100637 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Radiatetotheneck 4% (12/288) 2 Increasewithsquattingorhandgrip 60% (174/288) 3 Increasewithinspiration 14% (39/288) 4 Alsohaveamid-systolicclickloudestatS2 17% (48/288) 5 Haveacharacteristicmachine-likesound 3% (9/288) M2 QuestionComplexity E QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 2 ReviewTestedConcept ReviewFullTopic (M1.CV.13.117) A37-year-oldwomanpresentstoclinicforroutinecheckup.Shehasnocomplaintswiththeexceptionofoccasional"shortnessofbreath."Herphysicalexaminationisunremarkablewiththeexceptionofa"snap"-likesoundafterS2,followedbyarumblingmurmur.Younoticethatthismurmurisheardbestatthecardiacapex.Ahistoryofwhichofthefollowingareyoumostlikelytoelicituponfurtherquestioningofthispatient? QID: 100633 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Familyhistoryofaorticvalvereplacementatayoungage 6% (7/117) 2 Hyperflexibility,visionproblems,andpneumothorax 7% (8/117) 3 Systolicclickauscultatedonphysicalexam10yearsprior 5% (6/117) 4 Repeatedepisodesofstreptococcalpharyngitisasachild 78% (91/117) 5 Cutaneousflushing,diarrhea,andbronchospasm 0% (0/117) M2 QuestionComplexity B QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 4 ReviewTestedConcept ReviewFullTopic (M1.CV.13.142) A48-year-oldhomelessmanpresentstocliniccomplainingoffatigueandfeversthat"beganrecently."Cardiacexamrevealsaholosystolicmurmur,heardbestovertheleftlowersternalborder.Themurmurincreasesoninspiration.Healsohastrackmarksonhisarmsbilaterally.Thispresentationisconsistentwithwhichdefect? QID: 100658 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 Ventricularseptaldefect 6% (7/121) 2 Tricuspidregurgitation 74% (89/121) 3 Mitralregurgitation 16% (19/121) 4 Aorticstenosis 2% (3/121) 5 Pulmonarystenosis 2% (2/121) M2 QuestionComplexity C QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 2 ReviewTestedConcept ReviewFullTopic (M1.CV.13.28) A64-year-oldwomanwithahistoryofrheumaticfeverpresentstoherprimarycarecliniciancomplainingofexcessivefatiguewithwalkinganddifficultylyingflat.Shehadnopriorphysicallimitations,butrecentlyhasbeenunabletowalkmorethan3blockswithoutneedingtostopandrest.Hercardiacexamisnotableforalatediastolicmurmurheardbestattheapexintheleftlateraldecubituspositionwithnoradiation.Whatisthemostlikelydiagnosis? QID: 100544 Type&SelectCorrectAnswer Typeinatleastonefullwordtoseesuggestionslist Returnmultiplechoice 1 MitralRegurgitation 18% (34/186) 2 AorticStenosis 2% (3/186) 3 MItralStenosis 71% (132/186) 4 AorticRegurgitation 5% (9/186) 5 TricuspidRegurgitation 1% (2/186) M2 QuestionComplexity B QuestionImportance SelectAnswertoseePreferredResponse SUBMITRESPONSE 3 ReviewTestedConcept ReviewFullTopic evidenceFootprint SHOWEVIDENCE HIDEEVIDENCE Sortby EF L1\L2Evidence Date All Videos(9) LogintoViewCommunityVideos LogintoViewCommunityVideos TricuspidRegurgitation DonLi Cardiovascular -HeartMurmurs E 1/17/2016 143views 0.0 (0) LogintoViewCommunityVideos LogintoViewCommunityVideos Murmurspart2 KeshavMudgal Cardiovascular -HeartMurmurs D 6/17/2015 118views 5.0 (10) LogintoViewCommunityVideos LogintoViewCommunityVideos Murmurspart1 KeshavMudgal Cardiovascular -HeartMurmurs D 6/17/2015 218views 5.0 (11) Cardiovascular|HeartMurmurs Cardiovascular -HeartMurmurs   ListenNow 14:8min 5/24/2022 44plays 0.0 (0) SeeMore SeeLess Pleaselogintoaddcomment. ofimages Cancel Save