Heart Murmurs Flashcards
What are left systolic murmurs
aortic stenosis
mitral regurgitation
what are left diastolic murmurs
aortic regurgitation
mitral stenosis
what do you auscultate for aortic stenosis
aortic valve
both carotids
what do you auscultate for mitral stenosis
mitral valve (apex), roll onto left side and hold breath on expiration, use bell
what do you auscultate for mitral regurgitation
mitral valve and axilla
what do you auscultate for aortic regurgitation
ask patient to lean forward, auscultate left lower sternal edge and hold breath on expiration
What is heard in aortic stenosis plus fts
ejection systolic
radiates to carotids
louder on expiration
slow rising pulse
narrow pulse pressure
What murmurs are heard loudest on inspiration
Right sided murmurs
pulmonary stenosis
tricus regurg
What is heard in mitral stenosis
mid-late diastolic murmur
best heard on expiration
loud S1
opening snap
haemoptysis
sob
what is heard in mitral regurg
pansystolic/ holosystolic
high pithced, blowing
what is heard in aortic regurg
early diastolic murmur
high pitched blowing
collapsing
wide pulse pressure
Quincke’s sign - nailbed pulsation
De musset sign - head bobbing
what murmur is late systolic
mitral valve prolapse
coarctation of aorta
Innocent murmurs examples
Venous hums - continuos blowing
Still’s murmur - low pitched, lower left sternal edge
ejection systolic murmurs
aortic stenosis
HOCM
pulmonary stenosis
ASD
tetralogy of fallot
VSD murmur
pansystolic murmur
harsh
What is heard in HOCM
ejection systolic murmur, inc w valsalva manoevure n decrease on squatting
S4
innocent ejection murmur fts
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
may vary with posture
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child
Heart sounds what is S1
closure of mitral and tricuspid valves
soft if long PR or mitral regurgitation
loud in mitral stenosis
S2 heart sounds heard in?
closure of aortic and pulmonary valves
soft in aortic stenosis
splitting during inspiration is normal
S3 heart sounds heard in?
considered normal if < 30 years old (may persist in women up to 50 years old)
heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
S4 heart sounds heard in?
may be heard in aortic stenosis, HOCM, hypertension
caused by atrial contraction against a stiff ventricle
therefore coincides with the P wave on ECG
in HOCM a double apical impulse may be felt as a result of a palpable S4
what is heard in atrial septal defect
splitting of 2nd heart
ejection systolic
