Heart Murmurs Flashcards
Crescendo-decrescendo murmur heard best at the right second intercostal space with radiation to the carotids
Aortic Stenosis
Holosystolic murmur heard best at the cardiac apex with radiation to the axilla
Mitral regurgitation
Midsystolic click + Holosystolic murmur heard best at the cardiac apex with radiation to the axilla
Mitral valve prolapse
Harsh holosystolic murmur at the left sternal border
Ventricular septal defect
“Decrescendo murmur at the right or left second intercostal space”
Aortic regurgitation
Opening snap with diastolic rumble heard best at the cardiac apex
Mitral stenosis
“plop with diastolic rumble”
Atrial Myoxma
“Continuous machine-like murmur”
patent ductus arteriosis
Wide FIXED splitting
atrial septal defect
Name two reasons for wide splitting
- pulmonary stenosis
2. Right bundle branch block
Name two reasons for paradoxical splitting
- Left bundle branch block
2. aortic stenosis
When does an S3 occur and why?
Right after S2. Due to volume excess
Name reasons for S3
Eccentric hypertrophy (back flow, dilated cardiomyopathy), RAAS over-activation (fluid overload) normal in children, athletes and pregnant women
When does an S4 occur and why?
It occurs right before S1 and represents pressure excess
Name reasons for S4
concentric hypertrophy, stiffening of LV wall,
chronically increased afterload due to hypertension, aortic stenosis, HOCM
Which maneuvers DECREASE preload? (2)
Valsalva, standing,
Which maneuvers INCREASE preload? (2)
passive leg raise, squatting
Which maneuvers INCREASE afterload?
handgrip, rapid squatting
Name 7 causes of systolic mumurs
Aortic stenosis Pulmonary stenosis Mitral regurgitation Tricuspid regurgitation, VSD HOCM mitral valve prolapse
Name 3 causes of diastolic murmurs?
aortic regurgitation
mitral stenosis
atrial myoxma
What would happen to aortic stenosis murmur during standing?
Decrease in intensity due to decreased preload (less blood flow through stenotic vessel)
What would happen to aortic stenosis murmur during handgrip?
Decrease in intensity because you have less flow (less turbulence) so quieter murmur
What would happen to aortic stenosis murmur if you administered fluids
Increase in intensity because of increased preload
What would happen to mitral regurgitation murmur if you raised your legs?
Increased intensity of the murmur because increased preload means more backflow
What would happen to mitral regurgitation murmur during handgrip?
increase because increased afterload increases backflow
What would happen to an aortic regurgitation murmur if you did Valsalva maneuver?
it would decrease in intensity because you are decreasing preload to the heart and thus decreasing backflow of blood
What would happen to aortic regurgitation murmur if you squatted rapidly?
It would increase in intensity because more blood flowing backward from increased afterload
What would happen to HOCM murmur if you were to stand?
it would INCREASE in intensity because you are decreasing preload (increased volume pushes l. hypertrophy out of the way to create less obstruction)
What would happen to HOCM murmur during handgrip?
it would DECREASE because you’d have such little flow through that the murmur would become quieter.
What would happen to mitral valve prolapse if you did handgrip maneuver?
it would increase intensity of murmur becuase increased afterload makes it preferential for fluid to flow backward, making mitral valve prolapse simialr to mitral regurgitation
What would happen to mitral valve prolapse murmur if you gave nitrates?
it would INCREASE in intensity because of decreased preload the leaflets are more likely to prolapse
