Heart sounds Flashcards
Hypertrophic cardiomyopathy (HCM) murmur
Crescendo-decrescendo systolic murmur heard best at the left sternal border (functional stenosis);
If you move the stethoscope to the apex you will here a holosystolic blowing murmur due to the functional mitral regurgitation that accompanies the functional stenosis
What increases the intensity of HCM murmurs
Anything that decreases preload (i.e. decreases venous return); Valsalva and standing both decrease venous return and thus increase the murmur
Why does decreasing the venous return increase the murmur in HCM?
Decreases the ventricular size and decreases the area the blood flows across in systole thus increase the venturi effect and bring the mitral valve leaflet closer to the outflow tract
Heart sounds heard best at the right 2nd intercostal space
Aortic stenosis and aortic valve sclerosis; this is the “aortic area”
Heart sounds heard best at the left sternal border
Aortic and pulmonary regurgitation, HCM
Heart sounds heard best at the left 2nd intercostal space
Pulmonic stenosis; this is the “pulmonic” area
Heart sounds heard best at the left 5th intercostal space at the sternal border
Tricuspid regurgitation and stenosis, ASD and VSD; tricuspid area
Heart sounds heard best at the 5th intercostal space at the mid-clavicular line
Mitral regurgitation and stenosis; mitral area
Inspiration increases the intensity of what heart sounds
Right side; increases venous return to RV
Expiration increases the intensity of what heart sounds
Left; increase blood return to LV by “squeezing” blood of the pulmonary circulation
Hand grip increases the intensity of what sounds?
MR, AR, VSD and MVP
Hand grip decreases the intensity of what murmurs?
HCM, AS (decreases the pressure gradient by increasing systemic resistance)
Valsava decreases intensity of what murmurs?
Most murmurs
Valsava increases the intensity of what murmurs
MVP, HCM
Rapid squatting decreases the intensity of what murmurs
MVP, HCM
Rapid standing increases intensity of what murmurs
HCM
Systolic heart sounds
AS, PS, MR, TR, VSD
Diastolic heart sounds
AR, MR, MS, TS
What indicates the intensity of the MS
Interval between S2 and opening snap; earlier the OS the more severe the MS
Why does leaning forward increase AS
Brings the aorta valve closer to the chest wall
MVP is the leading risk factor for what?
Subacute bacterial endocarditis
Holosystolic, high pitched “blowing” murmurs
MR/TR
What enhances MR murmurs
Anything that increases systemic resistance (hand grip, squatting) or LA return (expiration)
What enhances TR murmurs
Anything that increases venous return (inspiration)
Major causes of MR
Ischemic heart disease, MVP, or LV dilation, rheumatic fever, infective endocarditis
Major causes of TR
RV dilatation, rheumatic fever, infective endocarditis
Holosystolic, harsh sounding murmur
VSD
Where is VSD loudest?
Tricuspid area (left 5th intercostal space at the sternal boarder)
Maneuvers that increase VSD
Things that increase systemic resistance (hand grip, sudden squatting)
Crescendo-decrescendo systolic murmur with an ejection click
Aortic stenosis
Where does the murmur radiate to in AS
Carotids and heart base
Weak pulses with a delayed peak are found in what murmur
AS; this is pulsus parvus et tardus
Sequelae of AS
SAD; syncope, angina, dyspnea
Common causes of AS
Bicuspid aortic valve, age related aortic calcific stenosis
Late-systolic murmur with a mid-systolic click
MVP
When is MVP loudest
S2; crescendos from the mid-systolic click
What can MVP predispose to?
Infective endocarditis
Causes of MVP
Myxomatous degeneration (most common), rheumatic fever, chordae rupture
Connective tissue diseases that may cause MVP
Ehler Danlos, Marfans
MVP is enhanced by what?
Diseases that decrease venous return (Valsava, standing quickly)
Immediate high-pitched “blowing” diastolic decrescendo murmur
Aortic regurgitation
Bounding pulse and head bobbing indicate what murmur
AR
Common causes of AR
Aortic root dilatation, bicuspid aortic valve, endocarditis, rheumatic fever
What increase AR murmur
Increased systemic resistance (hand-grip)
Tx for AR is what
Vasodilators/afterload reducers (ACE inhibitors, hydralazine)
Diastolic murmur with an opening snap, rumbling
MS
MS often caused by what
Rheumatic fever
Chronic MS can result in what?
LA dilatation
What enhances MS murmur
Things that increase LA return (expiration)
Continuous machine-like murmur
Most likely PDA; however, it could also be transposition of the great vessels
