Heart Murmurs Flashcards
When to refer for an ECG
- ANY cardiac symptoms with murmur
- ANY diastolic murmur
- grade 3+ systolic murmor
- other PE findings with murmur
- if unsure of significance
Characteristics to Describe
- intensity or grade
- I to VI
- 1: Shhh, 2: soft, 3: loud, 4: thrill, 5: louder, 6: w/out stethoscope
- pitch
- low or high
- timing
- midsystolic or holosystolic
- early, mid, late systolic
- early, mid, late diasolic
- continuous
- shape
- crescendo, decrescendo, crescendo-decescendo, plateau
- location
- aortic, pulmonic, erb’s, triscuspid, mitral
- radiation
- axilla, carotids, elsewhere
Clinical/Boards Pearls
(4 keys to know)
- geography (location) of murmur
- systolic/diastolic
- where it radiates
- treatment
Murmur Pneumonic
“ARMS and their partners (opposites)”
Diastolic Murmurs
- aortic regugitation
- mitral stenosis
Systolic Murmurs
- Aortic stenosis
- Pulmonic stenosis
- Mitral regurgitation
- Tricuspid regurgitation
- Mitral valve prolapse
- right 2nd intercostal space
- early diastolic
- low intensity, high pitch blowing
- listen w/ diaphragm, patient seated and leaning forward, firm pressure
https://www.easyauscultation.com/cases?coursecaseorder=1&courseid=27#
aortic regurgitation
- mid-diastolic
- low-pitch rumbling character
- left 5th intercostal space, lateral decubitus
- use bell at apex
https://www.easyauscultation.com/cases?coursecaseorder=3&courseid=27#
Mitral Stenosis
- right 2nd intercostal space
- mid-systolic murmur w/ harsh quality
- might have palpable thrill
- radiates to neck and both carotids
https://www.easyauscultation.com/cases?coursecaseorder=3&courseid=26#
Aortic Stenosis
- left 2nd intercostal space
- systolic injection murmur
- harsh
- often palpable thrill and radiates to left neck
https://www.easyauscultation.com/cases-listing-details?caseid=134#
Pulmonic Stenosis
- left 5th intercostal space in LLD position
- holosystolic murmur
- hight pitched blowing
- may have thrill and radiates into left axilla, left thorax, or base of neck
https://www.easyauscultation.com/cases?coursecaseorder=5&courseid=26#
Mitral Regurgitation
- diaphragm over left 4th intercostal space
- holosystolic murmur
- intensity can increase w/ inspiration (Carvallo’s sign)
https://www.easyauscultation.com/cases?coursecaseorder=2&courseid=28#
Tricuspid Regurgitation
- diaphragm in left 5th intercostal space
- MCC of late systolic murmur
- may be accentuated with squatting or level lags
https://www.easyauscultation.com/cases?coursecaseorder=6&courseid=26#
Mitral Valve Prolapse
