Heart Murmurs Flashcards
Crescendo-decrescendo systolic ejection murmur.
Aortic Stenosis
LV»_space; aortic pressure during systole. Loudest at heart base; radiates to carotids.
Aortic Stenosis
“Pulsus parvus et tardus”—pulses are weak with a delayed peak
Aortic Stenosis
Can lead to Syncope, Angina, and Dyspnea on exertion (SAD)
Aortic Stenosis
Often due to age-related calcification or early-onset calcification of bicuspid aortic valve.
Aortic Stenosis
Holosystolic, high-pitched “blowing murmur.”
mitral or tricuspid regurg
loudest at apex and radiates toward axilla.
Mitral Regurg
often due to ischemic heart disease (post-MI), MVP, LV dilatation
Mitral Regurg
loudest at tricuspid area and radiates to right sternal border.
Tricuspid Regurg
commonly caused by RV dilatation.
Tricuspid Regurg
Rheumatic fever and infective endocarditis can cause (two murmurs) what are they?
Mitral or Tricuspid Regurg
Late systolic crescendo murmur with midsystolic click (MC; due to sudden tensing of chordae tendineae
Mitral valve prolapse (MVP)
Most frequent valvular lesion
Mitral valve prolapse (MVP)
Best heard over apex. Loudest just before S2. Usually benign
Mitral valve prolapse (MVP)
Can predispose to infective endocarditis
Mitral valve prolapse (MVP)
Can be caused by myxomatous degeneration (1° or 2° to connective tissue disease such as Marfan or Ehlers-Danlos syndrome), rheumatic fever, chordae rupture
Mitral valve prolapse (MVP)
Holosystolic, harsh-sounding murmur. Loudest at tricuspid area.
VSD
High-pitched “blowing” early diastolic decrescendo murmur.
Aortic Regurgitation
Long diastolic murmur and signs of hyperdynamic pulse when severe and chronic causing head bobbing
Aortic Regurgitation
Often due to aortic root
dilation, bicuspid aortic valve, endocarditis, rheumatic fever.
Aortic Regurgitation
Progresses to left HF.
Aortic Regurgitation
Follows opening snap (OS; due to abrupt halt in leaflet motion in diastole, after
rapid opening due to fusion at leaflet tips).
Mitral Stenosis
Delayed rumbling late diastolic murmur ( decreased interval between S2 and OS correlates with increased severity).
Mitral Stenosis
LA»_space; LV pressure during diastole.
Mitral Stenosis
Often occurs 2° to rheumatic fever
Mitral Stenosis
Continuous machine-like murmur loudest at S2
PDA
Often due to congenital rubella or prematurity. Best heard at left infraclavicular area.
PDA
BEDSIDE MANEUVER:
Inspiration (increased venous return to right atrium)
increased intensity of right heart sounds
BEDSIDE MANEUVER:
Hand grip (increased afterload)
increased intensity of MR, AR, VSD murmurs
decreased in hypertrophic cardiomyopathy murmurs
MVP: later onset of click/murmur
BEDSIDE MANEUVER:
Valsalva (phase II), standing up (decreased preload)
decreased intensity of most murmurs (including AS)
BUT increased intensity of hypertrophic cardiomyopathy murmur
MVP: earlier onset of click/murmur
BEDSIDE MANEUVER:
Rapid squatting (increase venous return, increase preload)
decreased intensity of hypertrophic cardiomyopathy murmur and increased intensity of AS murmur
MVP: later onset of click/murmur
Wide fixed splitting of the second heart sound. Can lead to chronic pulmonary hypertension
ASD: chronic pulm HTN will lead to L–> R shunting and Eisenmenger syndrome
