Murmurs Flashcards
Pulmonic area
Pulmonic stenosis Flow murmurs (ASD, PDA)
Aortic area
Aortic stenosis
Flow murmur
Aortic valve sclerosis
Left sternal Border
Aortic regurgitation
Pulmonic regurgitation
Hypertrophic cardiomyopathy
Tricuspid area
Tricuspid regurgitation
VSD
Tricuspid stenosis
ASD
Mitral area
Mitral regurgitation
Mitral stenosis
PDA best heard at
Left intraclavicular region
Inspiration
Increase right heart sounds
Expiration
Increase left heart sounds
Left lateral decubitus
S3 sounds
Hand grip (increase TPR)
Increase:
MR, AR, VSD, MVP
Decrease:
AS, hypertrophic cardiomyopathy
Valsalva (decrease venous return)
Decrease most murmurs
Increase MVP, hypertrophic
Rapid squatting
Decrease MVP, hypertrophic
Mitral Regurgitation
Holosystolic high pitched blowing murmur Loudest at apex and radiates to AXILLA Increase by squatting and expiration More severe if S3 present Can be caused by rheumatic fever and infective endocarditis
Tricuspid regurgitation
Holosystolic high pitched blowing murmur
Loudest at tricuspid area and radiates to RIGHT STERNAL border
Increased by inspiration
Can be caused by RV dilation, rheumatic fever, infective endocarditis
Aortic stenosis
Crescendo decrescendo systolic ejection murmur following ejection click
LV»_space;» aortic P during systole
Radiated to carotids/ apex
Pulsus parvus et tardus
Syncope, angina, dyspnea
Most due to CALCIFIC aortic stenosis or bicuspid aortic valve
VSD
Holosystolic harsh sounding murmur
Loudest at tricuspid
Accentuated with hand grip maneuver to increase afterload
Mitral valve prolapse
Late systolic crescendo murmur with mid systolic click
Due to tensing of chordae tendinae
Most frequent valvular lesion
Best heard at apex, loudest at S2
Predisposes to infective endocarditis
Can be caused by myxomatous degeneration, rheumatic fever, chordae rupture
Enhanced by standing or valsalva
Aortic regurgitation
Immediate high pitched blowing diastolic decrescendo murmur
WIDE pulse pressure when chronic
Bounding pulses, head bobbing
Due to aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever
Increased by hand grip, vasodilators decrease it
Mitral stenosis
Follows opening snap, delayed late diastolic rumbling LA>>>LV pressure during diastole Most due to rheumatic fever Chronically can result in LA dilation Enhanced by expiration
PDA
Continuous machine like murmur. Loudest at S2
Due to congenital rubella or prematurity
Best heard at left infrclavicular area
