Murmurs Flashcards
A collapsing pulse and an early diastolic murmur are features of what valve problem?
aortic incompetence
What features are associated with Mitral Stenosis
- auscultation, examination and history
A classical low pitched mid-diastolic rumble.
Pre-systolic murmur In early MS
Malar flush ( usually when pulmonary hypertension is present)
A palpable first heart sound ( the tapping apex beat.)
Peripheral cyanosis on exertion: is characteristic of outflow obstruction,and is a feature of late disease.
Decreased ventricular filling followed by decrease in stroke volume,reduces peripheral perfusion.
Pre-systolic murmur In early MS
A third heart sound is a feature of what?
left ventricular failure
What murmur would you hear in left ventricular failure?
a Third heart sound
What murmur would you expect in Mitral Stenosis?
low pitched mid-diastolic rumble
What murmur would you expect in aortic incompetence?
Early Diastolic
What causes a Systolic murmur
Aortic valve stenosis = typically is a crescendo/decrescendo systolic murmur best heard at the right upper sternal border sometimes with radiation to the carotid arteries. In mild aortic stenosis, the crescendo-decrescendo is early peaking whereas in severe aortic stenosis, the crescendo is late-peaking, and the S2 heart sound may be obliterated.
Stenosis of Bicuspid aortic valve = is similar to the aortic valve stenosis heart murmur, but a systolic ejection click may be heard after S1 in calcified bicuspid aortic valves. Symptoms tend to present between 40 and 70 years of age.
Mitral regurgitation = typically is a holosystolic murmur heard best at the apex, and may radiate to the axilla or precordium.
A systolic click may be heard if there is associated mitral valve prolapse.
Valsalva maneuver in mitral regurgitation associated with mitral valve prolapse will decrease left ventricular preload and move the murmur onset closer to S1, and isometric handgrip, which increases left ventricular afterload, will increase murmur intensity. In acute severe mitral regurgitation, a holosystolic murmur may not be heard.
Pulmonary valve stenosis = typically is a crescendo-decrescendo murmur heard best at the left upper sternal border, associated with a systolic ejection click that diminishes with inspiration and sometimes radiates to the left clavicle.
Tricuspid valve regurgitation = presents as a holosystolic murmur at the left lower sternal border with radiation to the left upper sternal border. Prominent v and c waves may be seen in the JVP (jugular venous pressure). The murmur will increase with inspiration.
Hypertrophic obstructive cardiomyopathy (or hypertrophic subaortic stenosis) = will be a systolic crescendo-decrescendo murmur best heard at the left lower sternal border. Valsalva maneuver will increase the intensity of the murmur, as will changing positions from squatting to standing.
Atrial septal defect = will present with a systolic crescendo-decrescendo murmur best heard at the left upper sternal border due to increased volume going through the pulmonary valve, and is associated with a fixed, split S2 and a right ventricular heave.
Ventricular septal defect (VSD) will present as a holosystolic murmur at the left lower sternal border, associated with a palpable thrill, and increases with isometric handgrip. A right to left shunt (Eisenmenger syndrome) may develop with uncorrected VSDs due to worsening pulmonary hypertension, which will increase the murmur intensity and be associated with cyanosis.
What would you expect to hear (murmur wise) in severe aortic regurgitation?
a three phase murmur, specifically a midsystolic murmur followed by S2, followed by a parasternal early diastolic and mid-diastolic murmur (Austin Flint murmur). Although the exact cause of an Austin Flint murmur is unknown, it is hypothesized that the mechanism of murmur is from the severe aortic regurgitation jet vibrating the anterior mitral valve leaflet, colliding with the mitral inflow during diastole, with increased mitral inflow velocity from the narrowed mitral valve orifice leading to the jet impinging on the myocardial wall.
What murmur would you expect in severe coarctation of the aorta?
continuous murmur: a systolic component at the left infraclavicular region and the back due to the stenosis, and a diastolic component over the chest wall due to blood flow through collateral vessels.
What causes are there for a continuous systolic murmur?
Patent ductus arteriosus may present as a continuous murmur radiating to the back.
Severe coarctation of aorta
severe aortic regurgitation
How Does Aortic valve regurgitation present
a diastolic decrescendo murmur heard at the left lower sternal border or right lower sternal border (when associated with a dilated aorta).
This may be associated with bounding carotid and peripheral pulses (Corrigan’s pulse, Waterhammer pulse), and a widened pulse pressure.
What causes a diastolic murmur
diastolic murmurs occur with:
- aortic regurgitation (valve allows back flow during ventricular filling)
- Pulmonary valve regurgitation
- tricuspid stenosis - decrescendo at the left lower sternal border - look for signs of right heart failure
- Mitral stenosis typically presents as a diastolic low-pitched decrescendo murmur best heard at the cardiac apex in the left lateral decubitus position.
what abnormalities does a palpable S2 in the left intercostal space correlate with.
pulmonary hypertension
mitral valve stenosis
How does Tricuspid valve stenosis present
a diastolic decrescendo murmur at the left lower sternal border, and signs of right heart failure may be seen on exam.
How does Mitral stenosis typically present
diastolic low-pitched decrescendo murmur best heard at the cardiac apex in the left lateral decubitus position. It may be associated with an opening snap. Increasing severity will shorten the time between S2(A2) and the opening snap. (i.e. In severe MS the opening snap will occur earlier after A2)
