# During auscultation, the nurse hears a characteristic ______ murmur that increases with inspiration, suggesting tricuspid regurgitation.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168405  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

During auscultation, the nurse hears a characteristic ______ murmur that increases with inspiration, suggesting tricuspid regurgitation.

## 보기

1. holosystolic **✔ 정답**
2. diastolic
3. continuous
4. mid-systolic
5. early-systolic

**정답: 1**

## 해설

A holosystolic murmur heard throughout systole is characteristic of tricuspid regurgitation. The intensity increases during inspiration (Carvallo's sign) due to increased venous return to the right heart, making the regurgitation more prominent.

## 임상 시나리오

Tricuspid Regurgitation:
- Definition: Backward flow of blood from right ventricle to right atrium
- Timing: Holosystolic (throughout entire systole)
- Location: Right lower sternal border
- Intensity: Increases with inspiration (Carvallo's sign)
- Characteristics: High-pitched, blowing quality
- Associated findings:
* Jugular venous distention
* Hepatomegaly
* Peripheral edema
* Right-sided heart failure

Auscultation Techniques:
- Best position: Left lateral decubitus
- Bell vs. Diaphragm: Diaphragm preferred
- Grading: 1/6 to 6/6 intensity scale
- Radiation: May radiate to right chest

Cardiac Cycle Timing:
- Systole: Ventricular contraction phase
- Diastole: Ventricular relaxation phase
- Normal S1: Beginning of systole
- Normal S2: Beginning of diastole

## 핵심 개념

- **holosystolic** — A heart murmur that occurs throughout the entire systolic phase of the cardiac cycle, from the first heart sound (S1) to the second heart sound (S2)
- **diastolic** — A heart murmur that occurs during the diastolic phase of the cardiac cycle, when the heart chambers are filling with blood
- **continuous** — A heart murmur that occurs throughout both systole and diastole without interruption
- **mid-systolic** — A heart murmur that occurs in the middle portion of systole, not extending to either S1 or S2
- **early-systolic** — A heart murmur that occurs at the beginning of systole, immediately after S1, and does not extend throughout the entire systolic phase

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