Murmurs Flashcards
Name the Systolic murmurs
Aortic Stenosis Pulmonary stenosis Mitral regurgitation Tricuspid regurgitation Mitral valve prolapse
Name the diastolic murmurs
Aortic Regurgitation
Pulmonary regurgitation
Mitral stenosis
Tricuspid stenosis
What does S1 and S2 symbolize?
S1 = Closure of the mitral and triscupid valve S2 = Closure aortic and pulmonary valves
S1 to S2 = Systole (ventricular contraction - blood pump outs of the aorta/pulmonary artery)
S2 to S1 = Diastole ventricular relaxation - blood pumps through the mitral and tricuspid valve into the ventricles)
How do you grade murmurs?
Grade 1 = Heard only when listening intently over the area
Grade 2 = Faint murmur, heard immediately when auscultating
Grade 3 = Loud murmur, no palpable thrill
Grade 4 = Loud murmur + palpable thrill
Describe the murmur or aortic stenosis
Aortic stenosis is a systolic murmur best heard over the aortic region.
At the start of S1, when the mitral valve close, the stenotic aortic valve is not fully open. As the pressure in the ventricle increase, the stenotic valve ‘clicks’ open and this is heard as an ejection click. As the heart continues to contract, the valve is pushed open further and the murmur is heard louder - CRESCENDO.
As the heart begins to relax, less blood is ejected - DECRESCENDO, until the aortic valve close (S2).
This murmur is therefore a SYSTOLIC CRESCENDO- DECRESCENDO murmur.
How best to hear an Aortic Stenosis murmur?
Heard over the aortic region Radiates to the carotids/neck High + Low pitched sound Harsh quality to the sound Increased by squatting Decreased by clenching fist/abrupt standing (valsalva)
Describe the murmur of Mitral regurgitation
Mitral regurgitation is a systolic murmur best heard over the mitral region
At the start of S1, the mitral valve is meant to close to allow the ventricle to begin contracting. However, in mitral regurgitation, the valve does not close fully and blood re-enters the atria throughout systole.
As the ventricles contract, the pressure in the ventricle exceed the pressure in the atria and blood continues to pump into the atria. In chronic mitral regurgitation, the atria will expand to allow a greater volume/pressure to re-enter into the atria and therefore the murmur is heard throughout systole.
This murmur is therefore a PANSYSYOLIC MURMUR.
How best to hear a mitral regurgitation murmur?
Heard over the mitral region
Does not radiate
Blowing, musical quality
Increased by clenching fists
Describe the murmur of Aortic Regurgitation
Aortic regurgitation is a diastolic murmur best heard over the aortic region.
S2 is caused by the closing of the aortic valve and soon after the mitral valve open to allow the ventricle to fill (diastole).
In aortic regurgitaiton, the valve does not close fully and therefore blood re-enters the ventricle from an area of high pressure to low pressure
As the ventricle begins to fill, its pressure increases and so the murmur becomes diminished.
This murmur is therefore a DIASTOLIC DECRESCENDO MURMUR
How best to hear an aortic regurgitation murmur?
Heard along upper left sternal border
Blowing quality to sound
Increase intensity by clenching fist while squatting
Describe the murmur of Mitral stenosis
Mitral stenosis is a diastolic murmur heard over the mitral region.
S2 represents the closing of the aortic valve and milliseconds later the mitral valve opens. The atrial pressure causes the vale to open, but because the valve is stenotic it creates an opening ‘Snap sound’.
At the start of diastole the atrio-ventricular pressure is the greates adn rapid filling occurs. As the ventricle fills, the murmur becoem diminished - Decrescendo.
As the end of diastole, the atria contract to expell all the blood and this causes accentuates the murmur again - crescendo.
This murmur is therefore a PRE-SYSTOLIC DECRESCENDO-CRESCENDO MURMUR
How to best hear a mitral stenosis murmur?
- Heard over mitral area
- Low volume
- Rumbling quality to murmur
