Murmurs Flashcards
What are the normal heart sounds
S1 and S2
What does the S1 represent
Closure of the mitral and tricuspid valves
start of ventricular systole
peripheral pulse can be felt at this time
What does the second heart sound represent
Closure of the aortic pulmonary valves
Splitting-> difference between aortic and then pulmonary valve closing
Levine scale of cardiac murmurs
Intensity from 1-6
1) very faint, only heard by expert in optimum conditions
2) Heard by a non-expert in optimum conditions
3) Easily audible, no thrill
4) A loud murmur, with a thrill
5) Very loud, often heard over a wide area, with thrill
6) Extremely loud, heard without a stethoscope
What are the 5 areas to hear murmurs on the precordium
Which murmurs are best heard at the Aortic area (upper right sternal border)?
Systolic murmurs
-aortic stenosis
-flow murmurs (e.g,. physiological)
Which murmurs are best heard in the pulmonary area? (left pulmonic area)
systolic ejection murmurs
- pulmonary stenosis
-atrial septal defect
-flow murmur
Which murmurs can be heard loudest at ERBs point (upper left sternal border)
Diastolic murmur
- aortic regurg
-pulmonic regurg
Systolic murmur
-hypertrophic cardiomyopathy
Which murmurs can be heard loudest at the tricuspid area? (mid left sternal border)
Holosystolic murmur
- tricuspid regurg
-VSD
Diastolic murmur
- tricuspid stenosis
Which murmurs are heard loudest at the mitral area (apex- midclavicular 4/5 interclavicular space)
Holosystolic- mitral regurg
Systolic- mitral valve prolapse
Diastolic- mitral stenosis
What are the systolic murmurs (8)
Ejection systolic
-aortic stenosis
-pulmonary stenosis
Pansystolic (holosystolic)
-mitral regurg
-tricuspid regurg
-VSD
Mid-systolic
-mitral valve prolapse
-ASD
Late systolic
-coarctation of aorta
Diastolic murmurs (4)
Early diastolic
-aortic regurg
-pulmonary regurg
Mid-late diastolic
-mitral stenosis
-tricuspid stenosis
What does RILE stand for?
Right sided murmurs louder on inspiration
Left sided murmurs louder on expiration
Aortic stenosis
- ejection systolic murmur
- heard loudest over aortic area when leaning forward
- “crescendo-decrescendo”
- radiates to carotid arteries
Pulmonary stenosis
- associated with congenital heart defects like TOF
- ejection systolic heard loudest over pulmonary area
- loudest during inspiration
- radiates to shoulders/ left infraclavicular
- widely split
Mitral regurg
- pansystolic murmur
- high pitched and blowing in character
- heard best at mitral area (apex (5th intercostal, right sternal border, midclavicular line)
- radiates to axilla
Tricuspid regurg
- high pitched and blowing in character
- heard best at tricuspid area
- Tricuspid gets louder during inspiration, unlike mitral
Ventricular septal defect
heard loudest at the left lower sternal border
Mitral valve prolapse
- mid-systolic heard with an opening click
- loudest on expiration
- apex
Atrial septal defect
- crescendo-decrescendo
- machinery murmur
Coarctation of aorta
congenital defect
heard loudest in the back below the left shoulder blade
Aortic regurg
- early diastolic
decrescendo - water hammer pulse
- heard loudest above the left sternal edge
- high-pitched and blowing in character
-associated with head bob
Pulmonary regurg
- Early decrescendo murmur heard loudest over the left sternal edge
- Loudest during inspiration
- Usually due to pulmonary hypertension
Mitral stenosis
- low pitched “rumbling”
- opening click
- loudest over apex
- malar flush
- associated with causing AF or Aflutter
Tricuspid stenosis
- soft diastolic murmur heard loudest over left sternal age 3rd-4th intercostal space
- inspiration
- raised JVP
- peripheral oedema, ascites
Patent ductus arteriosus
continuous murmur heard loudest under the left clavicle
