Murmurs Flashcards
VSD
holosystolic, LLSB, mid-diastolic murmur if large shunt; usually maintly early systolic if small; MC pathologic murmur; normal S2; precordial radiation
MR
holosystolic, apex, higher pitched than VSD, radiates to axilla and back, blowing
ASD
systolic ejection, LUSB, persistent/fixed S2 split from RVOL, soft; can be crescendo-decrescendo
PDA
continuous diamond (crescendo-decrescendo), LUSB & L infraclavicular, bounding pulses, machine-like/rumbling; wide pulse pressure; associated with congenital rubella
AV stenosis
mid systolic ejection, RUSB, early systolic ejection click at apex, harsh, radiates to carotids, systolic thrill at suprasternal notch
supravalvular aortic stenosis
systolic ejection, ML-RUSB, no click
HOCM
systolic ejection, LLSB/apex, PMI laterally displaced; often grade 3 or 4 crescendo-decrescendo at ML-RUSB; may have thrill over precordium (not suprasternal), may have gallops
coarctation
systolic ejection, LUSB-left back mid-scap, pulse disparity
PV stenosis
mid systolic ejection, LUSB, ejection click, harsh but less so than ASD, wide S2 split but not fixed - varies with respiration, positive thrill
ToF
systolic ejection, MLSB, cyanosis
what gives ejection clicks?
PVS (early systole, L base, varies with respiration), aortic (apex, doesn’t vary), systolic (AS, bicuspid AV, ToF, or truncus arteriosis)
what gives non-ejection clicks?
[late systole at LLSB or apex] MVP
what causes a paradoxical split in S2? [AV after PV]
severe AS or LLSB causing delay in LV emptying
what causes a fixed split of S2? [AV then PV}
delayed RV emptying; ASD, RBBB, severe PS
when do you hear an S4?
atrial contraction fills the ventricle; always abnormal; AS, MR, HOCM, HTN causing LVH
