NUR 634 exam 2 || 100% Exact Answers.
innocent murmur correct answers left 2-4 ICS between left sternal border and apex, minimal
radiation, grade 1 or 2 possibly 3, soft to med pitch, variable quality, usually decreases or
disappears when sitting, normal splitting, no ejection sounds, no diastolic murmurs, no palpable
evidence of ventricular enlargement, mechanism- turbulent blood flow prob generated by
ejection of blood into aorta from left and occasionally right ventricle, common in children and
young adults, no underlying CVD, midsystolic
physiologic murmur correct answers left 2-4 ICS between left sternal border and apex, minimal
radiation, grade 1 or 2 possibly 3, soft to med pitch, variable quality, usually decreases or
disappears when sitting, signs of physiologic causes, mechanism- turbulence r/t increase in blood
flow in predisposing conditions such as anemia, pregnancy, fever, hyperthyroidism, midsystolic
aortic stenosis murmur correct answers 2nd and 3rd right ICS, radiation often to carotids/down
left sternal border/even to apex, if severe may radiate to left 2nd 3rd ICS, sometimes soft but
often loud with thrill, grade 4/6 and above, medium pitch, harsh, more musical at apex, known
maneuver to best hear, midsystolic
sitting and leaning forward correct answers position to best hear aortic stenosis murmur
aortic stenosis associated findings correct answers as this murmur worsens it peaks later in
systole, A2 decreases in intensity, A2 may be delayed and merge with P2, single S2 on expiration
or paradoxical split, carotid upstroke may be delayed with slow rise/small amplitude/decreased
volume, hypertrophied LV may produce sustained apical impulse and S4 r/t decreased
compliance, after 40 yo may be dilated aorta and murmur or aortic regurgitation, subendocardial
ischemia d/t poor coronary perfusion distal to valve causes angina and syncope
Mechanism of aortic stenosis correct answers significant stenosis causes turbulent flow across
valve increasing left ventricular afterload, most common cause is valve calcification in older
adults, can progress from non-obstructing sclerosis to stenosis, second most common cause is
congenital bicuspid valve not recognized until adulthood
, hypertrophic cardiomyopathy murmur correct answers location 3rd 4th ICS, radiation down left
sternal border to apex, poss at base but not to neck, variable intensity, medium pitch, harsh
quality, know maneuvers, carotid upstroke rises quickly, apical impulse sustained, S2 may be
single, S4 usually present at apex, usually benign but progresses in 25% to
syncope/ischemia/afib/dilated cardiomyopathy/ht failure/stroke/increased risk sudden death,
midsystolic
maneuver to detect hypertrophic cardiomyopathy correct answers intensity decreases with
squatting and valsalva release phase (increases venous return), increases with standing and
valsalva strain (decreases LV volume)
mechanism of hypertrophic cardiomyopathy correct answers unexplained diffuse or focal
ventricular hypertrophy with myocyte disarray and fibrosis associated with unusually rapid
ejection of blood from left ventricle during systole, outflow tract obstruction of flow may
coexist, associated distortion of mitral valve may cause mitral regurgitation
pulmonic stenosis murmur correct answers located 2nd 3rd ICS, radiation if loud toward left
neck and shoulder, soft to loud intensity, if loud associated with thrill, medium pitch, crescendo-
decrescendo, often harsh quality, midsystolic
pulmonic stenosis associated findings correct answers JVP usually normal but may have
prominent a wave, right ventricle impulse often sustained, early pulmonic ejection sound present
in mild to mod, if severe S2 widely split and P2 softens, may hear right sided S4 over left sternal
border
mechanisms of pulmonic stenosis correct answers primarily congenital disorder with valvular,
supravalvular, or subvalvular stenosis, stenosis impairs flow across valve, increasing right
ventricular afterload, in ASD increased flow across pulmonic valve may mimic this murmur
mitral regurgitation murmur correct answers pansystolic murmur, located at the apex with
radiation to left axilla, less often left sternal border, soft to loud intensity, if loud associated with
apical thrill, pitch medium to high, harsh, holosystolic quality, intensity doesn't change with
inspiration
innocent murmur correct answers left 2-4 ICS between left sternal border and apex, minimal
radiation, grade 1 or 2 possibly 3, soft to med pitch, variable quality, usually decreases or
disappears when sitting, normal splitting, no ejection sounds, no diastolic murmurs, no palpable
evidence of ventricular enlargement, mechanism- turbulent blood flow prob generated by
ejection of blood into aorta from left and occasionally right ventricle, common in children and
young adults, no underlying CVD, midsystolic
physiologic murmur correct answers left 2-4 ICS between left sternal border and apex, minimal
radiation, grade 1 or 2 possibly 3, soft to med pitch, variable quality, usually decreases or
disappears when sitting, signs of physiologic causes, mechanism- turbulence r/t increase in blood
flow in predisposing conditions such as anemia, pregnancy, fever, hyperthyroidism, midsystolic
aortic stenosis murmur correct answers 2nd and 3rd right ICS, radiation often to carotids/down
left sternal border/even to apex, if severe may radiate to left 2nd 3rd ICS, sometimes soft but
often loud with thrill, grade 4/6 and above, medium pitch, harsh, more musical at apex, known
maneuver to best hear, midsystolic
sitting and leaning forward correct answers position to best hear aortic stenosis murmur
aortic stenosis associated findings correct answers as this murmur worsens it peaks later in
systole, A2 decreases in intensity, A2 may be delayed and merge with P2, single S2 on expiration
or paradoxical split, carotid upstroke may be delayed with slow rise/small amplitude/decreased
volume, hypertrophied LV may produce sustained apical impulse and S4 r/t decreased
compliance, after 40 yo may be dilated aorta and murmur or aortic regurgitation, subendocardial
ischemia d/t poor coronary perfusion distal to valve causes angina and syncope
Mechanism of aortic stenosis correct answers significant stenosis causes turbulent flow across
valve increasing left ventricular afterload, most common cause is valve calcification in older
adults, can progress from non-obstructing sclerosis to stenosis, second most common cause is
congenital bicuspid valve not recognized until adulthood
, hypertrophic cardiomyopathy murmur correct answers location 3rd 4th ICS, radiation down left
sternal border to apex, poss at base but not to neck, variable intensity, medium pitch, harsh
quality, know maneuvers, carotid upstroke rises quickly, apical impulse sustained, S2 may be
single, S4 usually present at apex, usually benign but progresses in 25% to
syncope/ischemia/afib/dilated cardiomyopathy/ht failure/stroke/increased risk sudden death,
midsystolic
maneuver to detect hypertrophic cardiomyopathy correct answers intensity decreases with
squatting and valsalva release phase (increases venous return), increases with standing and
valsalva strain (decreases LV volume)
mechanism of hypertrophic cardiomyopathy correct answers unexplained diffuse or focal
ventricular hypertrophy with myocyte disarray and fibrosis associated with unusually rapid
ejection of blood from left ventricle during systole, outflow tract obstruction of flow may
coexist, associated distortion of mitral valve may cause mitral regurgitation
pulmonic stenosis murmur correct answers located 2nd 3rd ICS, radiation if loud toward left
neck and shoulder, soft to loud intensity, if loud associated with thrill, medium pitch, crescendo-
decrescendo, often harsh quality, midsystolic
pulmonic stenosis associated findings correct answers JVP usually normal but may have
prominent a wave, right ventricle impulse often sustained, early pulmonic ejection sound present
in mild to mod, if severe S2 widely split and P2 softens, may hear right sided S4 over left sternal
border
mechanisms of pulmonic stenosis correct answers primarily congenital disorder with valvular,
supravalvular, or subvalvular stenosis, stenosis impairs flow across valve, increasing right
ventricular afterload, in ASD increased flow across pulmonic valve may mimic this murmur
mitral regurgitation murmur correct answers pansystolic murmur, located at the apex with
radiation to left axilla, less often left sternal border, soft to loud intensity, if loud associated with
apical thrill, pitch medium to high, harsh, holosystolic quality, intensity doesn't change with
inspiration
