Murmurs Flashcards
Bedside maneuver: inspiration
- increases intensity of right heart sounds
Bedside maneuver: expiration
- increases intensity of left heart sounds
Bedside maneuver: hand grip (increased systemic vascular resistance)
- increases intensity of MR, AR, VSD, MVP
- decreases intensity of AS, hypertrophic cardiomyopathy murmurs
Bedside maneuver: valsalva (decreased venous return)
- decreases intensity of most murmurs
- increases intensity of MVP, hypertrophic cardiomyopathy murmurs
Bedside maneuver: rapid squatting (increased venous return, increased preload, increased afterload with prolonged squatting)
- decreases intensity of MVP, hypertrophic cardiomyopathy murmurs
Description of MR
- holosystolic, high-pitched “blowing murmur” that radiates towards axilla
- systolic murmur
Maneuvers that can increase intensity of MR
- increased TPR (squatting) or LA return (expiration)
Description of TR
- holosystolic, high pitched murmur that radiates towards right sternal border
- systolic murmur
Maneuvers that can increase intensity of TR
- increased RA return (inspiration)
Description of AS
- crescendo-decrescendo systolic murmur following ejection click
- radiates towards carotids/heart base
- systolic murmur
Description of VSD
- holosystolic, harsh-sounding murmur
Maneuvers that increase VSD
- hand grip due to increased afterload
- systolic murmur
Description of MVP
- late systolic crescendo murmur with midsystolic click
Maneuvers that increase MVP
- decreased venous return (standing or Valsalva)
- systolic murmur
Description of AR
- high pitched “blowing” decrescendo murmur
- bounding pulses, and head bobbing
- diastolic murmur
Maneuvers that increase or decrease AR
- increase: hand grip
- decrease: vasodilators
Description of MS
- follows opening snap
- delayed rumbling
- best heard in left lateral decubitus
- diastolic murmur
Description of PDA
- continuous machine-like murmur
Description of normal splitting
- delayed closure of pulmonic valve during inspiration
Description of wide splitting
- delayed closure of pulmonic valve regardless of breath
- an exaggeration of normal splitting
Conditions that can cause wide splitting
- any condition that delays RV emptying such as pulmonic stenosis or RBBB
Description of fixed splitting
- pulmonic closure is greatly delayed
Conditions that can cause fixed splitting
- ASD (left to right shunt)
Description of paradoxical splitting
- P2 sound occurs before delayed A2 sound
Conditions that can cause paradoxical splitting
- any condition that delays LV emptying such as aortic stenosis or LBBB