Heart Murmurs Flashcards
Continuous machinery murmur, loudest at LUSB
PDA
Systolic murmur loudest below left scapula
Coarctation of aorta (seen in Turner’s)
Harsh holosystolic murmur at LLSB
VSD
Widely split fixed S2 and systolic ejection murmur at LUSB
PFO or ASD
“Cooing dove”/high-pitched murmur, diastolic, heard over mid-precordium
Aortic regurgitation
Systolic crescendo-decrescendo heard over RUSB with radiation to carotids
Aortic stenosis
Systolic crescendo-decrescendo heard over RUSB with systolic ejection click
Calcified aortic stenosis 2/2 bicuspid valve
Holosystolic murmur heard best over the apex, radiates to axilla or precordium
Mitral regurgitation
Holosystolic murmur heard best over the apex, systolic click
Mitral valve prolapse
Valsalva with mitral valve regurgitation
Decreases preload, moves murmur closer to S1, decreases intensity
Isometric handgrip with mitral valve regurgitation
Increases afterload, increases intensity of murmur
Systolic crescendo-decrescendo murmur heard over LUSB associated with systolic click, radiates to left clavicle
Pulmonary valve stenosis
Holosystolic murmur at LLSB, increases with inspiration
Tricuspid valve regurgitation
Systolic crescendo-decrescendo murmur at LLSB
Hypertrophic Cardiomyopathy
Valsalva in HOCM
Decreases preload => increases intensity of murmur
Squatting to standing in HOCM
Decreases preload => increases intensity of murmur
Systolic crescendo-decrescendo heard best at RUSB, fixed split S2, RV heave
ASD
Diastolic decrescendo murmur at LLSB
Aortic regurgitation
Bounding carotid pulse (Corrigan’s pulse) and/or bounding peripheral pulse (Waterhammer’s pulse), widened pulse pressure
Aortic regurgitation
Diastolic low-pitched decrescendo murmur heard best at cardiac apex, associated with opening snap
Mitral stenosis
Diastolic decrescendo murmur at LLSB, signs of right heart failure
Tricuspid stenosis
Diastolic decrescendo murmur at LLSB
Pulmonary regurgitation
Carvallo’s maneuver
Inhale => increase in intrathoracic negative pressure => increases capacity of pulmonary circulation => prolongs ejection time => increases Right Heart Murmurs (usually tricuspid regurgitation)
Maneuvers to intensify HOCM murmur.
Valsalva => increases intrathoracic pressure => decreases preload => increase in murmur intensity
Maneuvers to decrease HOCM murmur
Squatting => increases systemic vascular resistance (and venous return) => increases afterload => helps hold obstruction in place
Maximum handgrip => increases systemic vascular resistance => …
