Heart murmurs help

[hmockingbird]

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My specific question: I just did a Pretest physio question asking what the murmur would be for this description: left sternal border, decreased pulse pressure, decreased diastolic pressure. I thought that was pretty vague, but I decided on pulmonary regurgitation. The answer was aortic regurg. Granted, I misread and thought that said stenosis so I got rid of it right away, but I still don't understand how you could tell the difference between aortic and pulmonary regurgitation in this question. Is it just b/c aortic regurg is more common? Or is there a physio reason maybe...?

This was my reasoning:
Diastolic murmur= regurg of A or P (open normally in systole), stenosis of M or T (open normally in diastole)
Decreased diastolic pressure supports regurg, because that would (passively) add to the volume in the ventricle, so you don't need to push as much from the atrium to the ventricle to get the same total volume in the ventricle i.e. less pressure needed
APTM for where you listen to the heart sounds: Left side is P, T, or M supporting pulmonary over aortic (Related question: Is this just meaningless? Because I swear, this got pounded into my head so much, but it seems like at least half the Kaplan questions I have ever done on murmurs switch this around, or make it super vague.)

Also in general, does anyone have a good way to remember or think through heart murmurs? It seems like I always get heart murmur questions wrong and I don't know why. Then I end up really frustrated because it takes me forever to think through those questions, and it ends up as wasted effort because I get them wrong anyway. This time, I felt like I thought it through ok, because most of the answer explanation was basically everything I had thought about (except it didn't specify why aortic and not pulmonary).

Thank you!

 

[notbobtrustme]

aortic regurg should be increase pulse pressure, did you mis-type it because that's a pretty big error if it made it into the test question.

I've never seen pulm regurg come up except when talking about RVHT/RVF.

 

[hmockingbird]

Yeah, I think that was a typo. Thanks

 

[Brain Bucket]

My specific question: I just did a Pretest physio question asking what the murmur would be for this description: left sternal border, decreased pulse pressure, decreased diastolic pressure. I thought that was pretty vague, but I decided on pulmonary regurgitation. The answer was aortic regurg. Granted, I misread and thought that said stenosis so I got rid of it right away, but I still don't understand how you could tell the difference between aortic and pulmonary regurgitation in this question. Is it just b/c aortic regurg is more common? Or is there a physio reason maybe...?

This was my reasoning:
Diastolic murmur= regurg of A or P (open normally in systole), stenosis of M or T (open normally in diastole)
Decreased diastolic pressure supports regurg, because that would (passively) add to the volume in the ventricle, so you don't need to push as much from the atrium to the ventricle to get the same total volume in the ventricle i.e. less pressure needed
APTM for where you listen to the heart sounds: Left side is P, T, or M supporting pulmonary over aortic (Related question: Is this just meaningless? Because I swear, this got pounded into my head so much, but it seems like at least half the Kaplan questions I have ever done on murmurs switch this around, or make it super vague.)

Also in general, does anyone have a good way to remember or think through heart murmurs? It seems like I always get heart murmur questions wrong and I don't know why. Then I end up really frustrated because it takes me forever to think through those questions, and it ends up as wasted effort because I get them wrong anyway. This time, I felt like I thought it through ok, because most of the answer explanation was basically everything I had thought about (except it didn't specify why aortic and not pulmonary).

Thank you!

Copy the Q here? The questions in which we had to pick out Pulm regurg, there would be something there to indicate it, like pulm htn, or that the murmur was louder during inspiration.

BTW, for all things cardio, I recommend Lilly.

 

[boogaloo]

My specific question: I just did a Pretest physio question asking what the murmur would be for this description: left sternal border, decreased pulse pressure, decreased diastolic pressure. I thought that was pretty vague, but I decided on pulmonary regurgitation. The answer was aortic regurg. Granted, I misread and thought that said stenosis so I got rid of it right away, but I still don't understand how you could tell the difference between aortic and pulmonary regurgitation in this question. Is it just b/c aortic regurg is more common? Or is there a physio reason maybe...?

This was my reasoning:
Diastolic murmur= regurg of A or P (open normally in systole), stenosis of M or T (open normally in diastole)
Decreased diastolic pressure supports regurg, because that would (passively) add to the volume in the ventricle, so you don't need to push as much from the atrium to the ventricle to get the same total volume in the ventricle i.e. less pressure needed
APTM for where you listen to the heart sounds: Left side is P, T, or M supporting pulmonary over aortic (Related question: Is this just meaningless? Because I swear, this got pounded into my head so much, but it seems like at least half the Kaplan questions I have ever done on murmurs switch this around, or make it super vague.)

Also in general, does anyone have a good way to remember or think through heart murmurs? It seems like I always get heart murmur questions wrong and I don't know why. Then I end up really frustrated because it takes me forever to think through those questions, and it ends up as wasted effort because I get them wrong anyway. This time, I felt like I thought it through ok, because most of the answer explanation was basically everything I had thought about (except it didn't specify why aortic and not pulmonary).

Thank you!

Pulmonary regurgitation shouldn't cause a change in pulse pressure; the amount of blood that arrives in the left atrium/ventricle is decreased, but the aortic valve is intact (i.e., not leaking). Blood pressure may be decreased slightly before vascular compensation, but the pulse pressure should stay the same.

 

[boogaloo]

Also in general, does anyone have a good way to remember or think through heart murmurs? It seems like I always get heart murmur questions wrong and I don't know why. Then I end up really frustrated because it takes me forever to think through those questions, and it ends up as wasted effort because I get them wrong anyway. This time, I felt like I thought it through ok, because most of the answer explanation was basically everything I had thought about (except it didn't specify why aortic and not pulmonary).

Thank you!

I think it's good that you're trying to understand the different heart murmurs instead of memorizing them. That's an important thing to do, especially when it comes to Step I. I think about it in big steps and then focus on the details:

1. Systolic or diastolic (diastolic in this case--A/P regurg or T/M stenosis like you said).
2. APTM (A or P in this case--left sternal border doesn't always mean P).
3. Details: change in pulse pressure and diastolic pressure, values which are unaffected by PR and classically affected by AR.

I think you just put too much emphasis on the left sternal border and misread AR for AS. Remember that murmurs happen because of turbulent flow, and where you hear the murmur is where the blood is going (e.g., carotid radiation in AS, axillary radiation in MR, etc.). If you have a patient with AR, the blood is flowing backwards into the left ventricle, which is actually closer to the left sternal border than the right sternal border. You're getting it mixed up with aortic valve closure.