Murmurs Flashcards
mid-diastolic murmur at apex
mitral stenosis
pansystolic murmur at apex
mitral regurgitation
mitral regurgitation
pansystolic murmur
mitral stenosis
mid-diastolic murmur
ejection systolic in aortic region
aortic stenosis
aortic stenosis
ejection systolic over aortic region
aortic regurgitation
early diastolic in left sternal edge
early diastolic in left sternal edge
aortic regurgitation
mitral valve prolapse
mid systolic click followed by mid or late systolic murmur
at apex
tricuspid regurgitation
pansystolic murmur at tricuspid region
pulmonary stenosis
ejection systolic murmur over pulmonary area
louder on inspiration
radiates to L shoulder or infraclavicular region
tricuspid stenosis
soft diastolic murmur over 3rd-4th intercostal space at left sternal edge
- rarely audible
mitral regurgitation features
- Most common
- Displaced apex
- Apical thrill
- S1 quiet
- Pansystolic murmur radiating to the axilla
- S3 present (rapid ventricular filling) Look for valvotomy scar (under the breast)
mitral stenosis features
- Malar flush
- Middle aged female
- Atrial fibrillation
- Tapping apex heart (palpable and very low S1, because mitral valve is narrow, atrium has to ↑ contractive force prior to systolic starting)
- Non displaced apex
- RV heave
- Blowing mid diastolic murmur with presystolic accentuation (not AF)
aortic regurgitation features
- Collapsing pulse pressure
- Corrigan’s sign (visible neck pulse)
- De Musset’s sign (head nodding with heartbeat)
- Quincke’s sign (capillary pulsation in nail bed)
- Dynamic apex
- Early diastolic murmur at left sternal edge
- Systolic flow murmur
- Luetic, marfans, ankylosing spondylitis, Reiter’s, endocarditis, old rheumatic fever
aortic stenosis features
- Slow rising pulse
- Carotid bruit
- Ejection systolic murmur
- 4th heart sound
- Heaving apex
- Ejection click
- Quiet second heart sound
differentials for low pitched mid-diastolic murmur heard at apex
- mitral stenosis
- Austin Flint murmur (2o to AR)
- Carey Coombs murmur (rheumatic fever, mitral valvulitis, disappears when vasculitis improves)
- Tricuspid stenosis (usually rheumatic)
differentials for blowing pansystolic murmur at apex
- mitral regurgitation
- VSD (important post MI)
- Tricuspid regurgitation (giant V waves JVP, pulsatile hepatomegaly)
- AS
differentials for crescendo-decrescendo ejection systolic murmur over aortic region
- aortic stenosis
- Aortic sclerosis
- HOCM
- Pulmonary stenosis (usually congenital)
- Mitral regurgitation
differentials for early diastolic murmur heard when sitting up in expiration at LLSE
- aortic regurgitation
- Pulmonary regurgitation
- Graham Steele murmur (PR secondary to pulmonary HTN)
what signs aortic stenosis associated with?
S4, heaving apex, slow-rising, narrow pulse pressure, ejection click, quiet S2 (severe)
what signs is AR associated with?
S3, thrusting/displaced apex, collapsing pulse, wide pulse pressure, eponymous signs, Austin flint murmur (mid-diastolic)
what signs is MR associated with?
S3, thrusting/displaced apex, quiet S1, obliterated S2, AF
Audible click → valve prolapse
what signs is MS associated with
AF, opening snap, tapping apex, loud S1, mitral facies (malar flush), RHF signs