Heart Murmurs Flashcards
Mitral/Tricuspid Regurgitation Description
Holosystolic, High-Pitched Blowing Murmur
Where is MR heard and radiated to?
- Loudest at apex.
- Radiates toward axilla.
What is MR enhanced by?
- Enhanced by maneuvers that increase TPR (squatting, hand grip) or LA return (expiration).
Causes of MR
Ischemic Heart Disease, Mitral Valve Prolapse Rheumatic Fever, Infective Endocarditis, or LV Dilation (DCM)
Where is TR heard and radiated to?
Loudest at tricuspid area and radiates to right sternal border
TR Enhanced by
Maneuvers that increase RA return (inspiration)
Causes of TR
RV Dilation (DCM), Rheumatic Fever, and Infective Endocarditis
Description of Aortic Stenosis
- Crescendo-Decrescendo Systolic Ejection Murmur Following Ejection click due to abrupt halting of valve leaflets.
Aortic Stenosis radiates to
Carotids/heart base
Aortic Stenosis can lead to
SAD
- Syncope, Angina, and Dyspnea on exertion
Aortic Stenosis often due to
Age-related (>70 yrs) calcific aortic stenosis or bicuspid aortic valve (congenital and shows up ages 50-60 yrs)
Findings of Aortic Stenosis
LV Hypertrophy (common) and LV pressure greater than Aortic Pressure during Systole
Ejection Click of Aortic Stenosis occurs
Just after S1
Description of Ventricular Septal Defect (VSD)
Holosystolic, Harsh-Sounding Murmur
VSD Found at and enhanced by
- Tricuspid area
- Enhanced by hand grip maneuver due to increased afterload
Description of Mitral Valve Prolapse (MVP)
Late Systolic Crescendo murmur with midsystolic click due to sudden tensing of the chordae tendineae.
MVP Best Heard Where and When
- Heard over apex and loudest right before and at S2.
MVP caused by
Myxomatous degeneration, rheumatic fever, or chordae rupture.
MVP Enhanced by
Maneuvers that decrease venous return (standing or valsalva)
MVP Findings and Typical Patients
- Fibrosa layer (strength of leaflet) is thinned with myxomatous expansion of the spongiosa.
- Young Women
Description of Aortic Regurgitation (AR)
Immediate high-pitched blowing diastolic decrescendo murmur heard right after S2.
Pts with AR present with
Wide pulse pressure when chronic, bounding pulses and head bobbing (due to hyperdynamic circulation).
AR Often due to
Aortic Root Dilation, bicuspid aortic valve, endocarditis, or rheumatic fever.
AR enhanced and decreased by
- Enhanced during hand grip and decreased intensity with vasodilators
Description of Mitral Stenosis
- Follows opening snap due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips.
MS sounds like
Rumbling late diastolic murmur
Chronic MS can result in
LA dilation due to LA pressure being greater than LV pressure during diastole
MS enhanced by
Maneuvers that increase LA return (expiration, Pulmonary congestion/HTN, Atrial Fibrillation
MS Often occurs secondary to
Rheumatic Fever
Description of PDA
Continuous machine-like murmur that is loudest at S2 and best heard at the left infraclavicular area.
PDA Often due to
Congenital Rubella or Prematurity
