Heart Murmurs Flashcards
Aortic Regurgitation
High-pitched, Blowing
Diastolic murmur @ Left Sternal Border
Widened Pulse Pressure
(/Bounding/Water Hammer)
Pulsus Bisferiens (double systolic pulsation)
May cause Austin Flint murmur @ Apex:
Mid-Diastolic, low-pitched rumbling due to vibration of anterior leaflet of Mitral valve as it is buffeted simultaneously by the blood jets from both the left atrium and the aorta.
Caused by Aortic Dissection (terrible pain down back), Ankylosing Spondylitis, Syphillis, Marfan’s
Pulmonic Regurgitation
Decrescendo Diastolic murmur
@ Left lower Sternal Border
Secondary to Pulmonary Hypertension, Bacterial Endocarditis, or Tetralogy of Fallot
Difficult to hear bc of low right side pressures.
Difficult to distinguish from Aortic Regurge.
Mitral Stenosis
Low-Frequency, Rumble
Diastolic murmur @ Apex in Left Lateral Decubitus position
Thrill may be present
Caused by Rheumatic Fever or Endocarditis
Lead to LAH and CHF
Tricuspid Stenosis
Mid-Diastolic Opening Snap
Diastolic Murmur @ Left Sternal Border
Increased by Inspiration
Large A waves
May cause S1 split
Often accompanied by Mitral Stenosis.
Almost always due to Rheumatic Fever.
Rare.
Patent Ductus Arteriosus
Continuous, “machine-like” murmur
@ Left Sternal Border
JVD
Widened Pulse Pressure
Thrill often present
Exertional Dyspnea, Poor Feeding, increased pulmonary pressures
Prostaglandin E1 (open) Indomethacin (close)
= some blood from left heart returns to lungs
Coarctation of Aorta
Systolic murmur
Radiates to Back
Diminished Femoral Pulses
BP higher in Upper extremities than Lower
Rib Notching
Usually at descending aorta.
Increased risk for Aortic Dissection, Heart Failure, Endocarditis.
Atrial Septal Defect (ASD)
Fixed S2 Split
Systolic murmur @ Pulmonic area
Radiates to Back
(Murmur due to increase flow over pulmonic valve)
May have brief diastolic murmur of flow across the tricuspid from ASD.
Dyspnea, Frequent Respiratory Infections (b/c Pulmonary Congestion), Palpitations.
Symptoms usually manifest by age 30.
Mostly asymptomatic if small defect.
Large defect closed surgically.
Increased risk for Endocarditis, Heart Failure, Atrial Fibrillation (b/c RA dilation, causing arrhythmia b/c that is where SA node is).
Pulmonic Stenosis
Mid-Systolic murmur @ Pulmonic area
May radiate to Neck or Back
Increased by Inspiration.
Decreased by Valsalva.
Large A wave
Delayed/Split S2
RV Heave, Thrill
Displaced/Widened Apical Impulse (PMI) @ sternum
Hx of heart murmur since birth
Mostly Asymptomatic (Crescendo-Decrescendo)
Aortic Stenosis
Mid-Systolic murmur @ Aortic area (RUSB)
May radiate to Carotids
Paradoxical S2 Split (Split during Expiration) (Pulmonic valve closes before Aortic)
Pulsus Tardus (delayed systolic upstroke)
Decreased by Valsalva
Angina, Exertional Fatigue, Dizziness, Syncope.
Crescendo-Decrescendo
Caused by Congenital Bicuspid Aortic Valve, Aortic sclerosis (aging), Rheumatic disease.
Leads to LVH, CHF
Tetralogy of Fallot
Cyanotic @ Birth
Systolic murmur @ Left Sternal border
Radiates to Left Carotid
Parasternal Heave due to RVH
Tet Spells and Squatting
ToF = VSD, Pulmonic Stenosis, Dextroposition of Aorta, RVH
Central cyanosis with exertion or agitation; may squat to alleviate.
Failure to thrive (poor growth and development), loss of consciousness, clubbing, poor feeding.
Ventricular Septal Defect (VSD)
Holo-Systolic murmur @ Left Sternal border
Loud, High-pitched, Coarse
Late Cyanosis (Cyanosis Tardive) weeks after birth or age 1-2.
Blue spells, tachypnea, Dyspnea, Failure to thrive, excessive work to feed.
Most small defects close spontaneously.
Good outcome for surgery on larger defects.
Can cause Eisenmenger’s Syndrome and RVH.
Tricuspid Regurgitation
Holo-Systolic murmur @ Left Sternal border
Low-frequency
Increased by Inspiration.
Decreased by Valsalva, Standing.
S3, Thrill are common
Large V waves
Absent x descent
Hepatojugular Reflux: press on Liver to increase JVP.
Enlarged liver (hepatomegaly)
Parasternal heave b/c RVH
Mostly asymptomatic.
Caused by congenital, bacterial endocarditis, pulmonary hypertension, trauma.
Rare.
Mitral Regurgitation
Holo-Systolic murmur @ Apex
Radiates to Axilla
Increased by Squatting
S3 often present
Mostly asymptomatic
Caused by Rheumatic heart disease, Mitral Valve Prolapse, Endocarditis, Marfan’s, MI
Mitral Valve Prolapse
Mid-Systolic Click
Increased by Valsalva, Standing
Decreased by Squatting
Sometimes followed by a late systolic Mitral Regurgitation murmur @ Apex.
May or may not cause mitral regurgitation.
Both the murmur and click move closer to S1 (right after S1) and get louder and longer with Valsalva, Standing. Opposite with Squatting.
Mostly asymptomatic.
Chest pain, SOB, Anxiety.
Caused by Marfan’s, Grave’s disease (Hyperthyroid)
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Systolic murmur @ Left Sternal border
Increased by Valsalva and Standing
Decreased by Squatting
May have Pulsus Bisferiens, Double Apical Impulse, Double Heave
May have mitral regurgitation if both LV walls hypertrophy.
Often asymptomatic until exert.
Dyspnea, SOB, Angina, palpitations, lightheaded, Syncope, CHF. Sudden death.
(Symptoms present like Aortic Stenosis. But aortic stenosis is decreased by Valsalva )
