Heart Murmurs Flashcards
Mitral valve prolapse
Mid systolic click then with late systolic crescendo murmur
Heard at apex
Causes-myxomatosis degen, in marfans, rheum fever, chordae tendonae rupture
Earlier click if decrease venous return-stand, Vasalva
Most frequent and usually benign but may be site for endocarditis
Mitral or tricuspid regurgitation
HoloSYSTOLIC high pitched blowing
Both can be caused by rheum fever of endocarditis
Mitral-apex with radiation to axilla
Increas with increased TPR-squat, handgrip
Tricuspid-5th intercostal space left of sternum, radiate to right stern all border
Increase with increased RA return…inspiration
Aortic stenosis
Crescendo-decrescendo during systole because left ventricle pressure much higher than aortic due to stenosis
At heart base-right sternal border 2nd intercostal space, radiates to carotids
Age-related calcification, bicuspid aortic
Increase with squatting/inspiration, decrease with standing/Vasalva, hand grip
Ventricular septal defect
Holo systolic HARSH sounding murmur
Heard at left sternal border 5th intercostal space-tricuspid area
Increase with handgrip
Aortic regurgitation
High pitched blowing during early diastole, decrescendo
Hear at left sternal border upper
Wide pulse pressure, bounding pulses, head bobbing
Aortic root dilation, bicuspid aortic valve, endocarditis, rheum fever
Increase during hand grip, vasodilators decrease
Mitral stenosis
Diastolic, opening snap, then delayed rumbling late diastole
Worse if short time between s2 and snap
Rheum fever
Increase with increased LA return like expiration
PDA
Machine-like continuous murmur, loudest during s2
Congenital rubella or premature
Left infraclavicular area loudest
Tetralogy of fallot
Stenotic pulm trunk
Large aorta
Vsd
Hypertrophied r ventricle (boot shape)
Stenotic pulm–>r to l shunt–>cyanosis–>improve with squatting sue to increased peripheral resistance–> reversal of shunt
Holosystolic blowing high pitched murmur at mid clavicular 5th intercostal space OR at apex radiating to axilla
Increases with squatting and inspiration
Mitral regurgitation
Holosystolic high pitched blowing murmur
Heard at leftsternal border , 5th intercostal
Increases with squatting and inspiration
Tricuspid regurgitation
Holosystolic harsh sounding murmur
Heard at leftsternal Border 5th iimtercostal space
Increases with hand grip
Ventricular septal defect
Hand grip increase due to increased systemic vasc resistance–> increase afterload–> more blood through VSD due to high L pressure
Crescendo decrescendo murmur during systole
Heard at base, radiates to carotids
Aortic stenosis
Increases with rapid squatting due to increased return
Mid systolic click followed by crescendo
Heard over apex
When stand or expire against resistance, click occurs earlier
Mitral valve prolapse
Click due to suddenly tensed chordate tendonae as pulled on by loose ballooning leaflets
Mitral incompetence due to lengthening of leaflets and chordae tendonae
High LV volume pushes leaflets into proper position and causes proper closing
Diastolic snap then rumble
Heard at apex
Increases with expiration
Mitral stenosis
Snap due to rapid halt of fused leaflet motion during fast opening
Worse if snap soon after s2 because this means VERY stenotic..not able to open very much before abrupt halt in opening movement due to fused leaflets
Rumble through stenotic valve as fills ventricle
Diastolic high pitched blowing
Head bobbing and wide pulse pressure
Hear at upper left sternal border
Increases with hands grip
Decreases with vasodilators
Aortic regurgitation
