MURMURS Flashcards
Crescendo-descrescendo systolic murmur
Aortic Stenosis
- Harsh blowing holosystolic murmur
- Midsystolic click
Mitral Regurgitation
Diastolic decrescendo murmur
Aortic Regurgitation
- Austin Flint murmur (late diastolic rumble)
- Quincke sign
Aortic Regurgitation
Aortic Stenosis - causes
- congenital defect
- calcifications (elderly)
Machine-like murmur
Patent Ductus Arteriosus
Aortic Stenosis - symptom/PE, CXR/ECHO, Tx
- syncope
- CP
- weak pulse/prolonged
- RADIATES TO CAROTIDS (from R sternal border)
- VALSALVA WEAKENS
- dilated aorta
- valve replacement
Mitral Regurgitation - causes
- RHD
- MV prolapse
- pap mm dysfxn (MI)
Mitral Regurgitation - symptoms/PE, CXR/ECHO, Tx
- palpitations
- orthopnea
- PND
- RADIATES FROM APEX TO AXILLA
- S3
-LA enlargement/LVH
- vd (symptomatic)
- anticoag (afib or emboli hx) –> when atria enlarge = risk of AFIB
Aortic Regurgitation - symptoms/PE, CXR/ECHO, Tx
- CP
- orthopnea
- bounding pulses/widened pulse P
- dilated aorta
- LV enlargement
- ACEi, CCB, or nitrates (decr afterload)
- valve replacement
Mitral Stenosis - causes
RHD
Mitral Stenosis - symptoms/PE, CXR/ECHO, Tx
- DIASTOLIC RUMBLE
- opening snap after S2
- loud S1
-“mid-diastolic rumbling murmur”
Tricuspid Regurgitation
- HOLOSYSTOLIC
- RADIATES TO R STERNUM and XIPHOID
- JVP
Pulmonic Stenosis
- MIDSYSTOLIC CRESCENDO-DECRESCENDO
- RADIATES TO LEFT SHOULDER and NECK
- early pulmonic ejection sound
Diastolic Murmurs
almost always means heart disease
- aortic regurg
- mitral stenosis
- pulm regurg
- tricuspid stenosis
DIASTOLIC
~early –> regurg flow through imcompetent valve (aortic MC)
~rumbling = mid/late diastole (sugg stenosis of AV valve (mitral MC))
AORTIC REGURG
- soft
- high pitched
- blowing diastolic
- LSB
- sitting, leaning fwd, post exhale
MITRAL STENOSIS
- diastolic
- low pitched, decresendo, rumbling
- opening snap at apex
PULM REGURG
- high-pitched, descrendo, LSB
- increases with inspiration
TRICUSPID STENOSIS
- mid diastolic, rubmbling, LLSB
- opening snap
Midsystolic murmurs
- AKA EJECTION MURMURS*
- MC KIND OF MURMUR*
- PATHOLOGICAL, PHYSIOLOGICAL, INNOCENT*
- aortic stenosis
- pulmonic stenosis
- HCOM
- mitral valve prolapse
AORTIC STENOSIS
- midsystolic ejection
- crescendo-decrescendo
- RUSB
PULMONIC STENOSIS
- hard midsystolic ejection
- crescendo-decrescendo
- widely split S2
- LSB and radiates to left shoulder/neck
HCOM
- medium-pitched, midsystolic
- DECREASED w/ squatting and INCREASED with straining
- S4 gallop and apical lift
- stiff left ventricle
MITRAL VALVE PROLAPSE
-midsystolic ejection click at apex
Pansystolic (holosystolic) murmurs
*pathologic - when blood flows from area of high to low pressure chamber
- mitral regurg
- tricuspid regurg
- ventricular septal defect
MITRAL REGURG
- blowing holosystolic murmur at apex
- split S2
TRICUSPID REGURG
-high-pitched holosystolic murmur at mid LSB
VENTRICULAR SEPTAL DEFECT
- harsh holosystolic murmur
- LSB with wide radiation
- fixed/split S2
