Murmurs Organized Flashcards
Valvular stenosis
tightness of valve incr pressure of blood thru valve
valvular insufficiency/regurg
leakiness, blood in opposite direction
S1
closing of mitral and tricuspid
M1 or T1 which is louder
M1 louder because higher pressure in left heart
S2
closing of aortic and pulmonic valve
A2 or P2 which is louder
A2 louder because higher pressure in left heart
Physiologic split S2
A2 occurs before P2 by significant difference due to INSPIRATION (incr venous return to right delays closing of P2)
S3
after S2 when passive large amount of blood strikes compliant LV
S3 found when
systolic HF due to compliant LV (dilation)
S4
before S1 when active atrial contraction forces blood into non-compliant LV
S4 found when
diastolic HF from severe LVH causing decr complaince of LV
any condition that creates a non-compliant LV (diastolic HF) will produce ___
S4
any condition that creates an overly compliant LV (systolic HF)
S3
systolic ejection click
bicuspid aortic valve
after S1 - doming of 2 leaflets before opening
mitral valve prolapse click
mid-systolic click then high-pitch murmur
due to mitral regurg
opening snap
mitral valve leaflets tense and dome into LV in early diastole
mitral stenosis
What happens between S1-S2
systole
What happens after S2
diastole
systole
between S1-S2
diastole
after S2
Aortic stenosis
describe
diamond mid systolic continuous
aortic stenosis
auscult site
2nd RICS
aortic stenosis change with respiration
expiration intensify murmur
what can distinguish between mild and severe aortic stenosis
mild = peaks early in systole
severe = peaks late in systole
pulmonic stenosis
describe
diamond midsystolic high pitch
pulmonic stenosis
auscult site
2nd-3rd LICS
pulmonic stenosis change with respiration
inspiration intensify murmur
what can distinguish between mild and severe pulmonic stenosis
mild = peaks early in systole
severe = peaks late in systole
Hypertrophic Obstructive cardiomyopathy murmur
midsystole, diamond, high pitch
hypertrophic obstructive cardiomyopahty
auscult site
left lower sternal border
Mitral regurgitation
describe
holosystolic “blowing” high pitch
mitral regurg
auscult site
apex
mitral regurg
change with respiration
no change with inspiration
separate from tricuspid regurg
tricuspid regurg
describe
holosystolic high pitch
tricuspid regurg
auscult site
left lower sternal border radiate to right lower sternal border
tricuspid regurg change with respiration
increased intensity with inspiration
mitral valve prolapse
describe
midsystolic click then high pitch
tightening of chordae
due to mitral regurg
mitral valve prolapse
auscult site
apex
aortic regurg
describe
early diastolic, descrendo, high pitch
aortic regurg
auscult site
left 3rd ICS
aortic regurg
change with disease severity
as aortic regurg worsens, pressure btwn LV and aorta equalize so murmur shorter
austin flint murmur
early diastolic rumble at apex due to regurgitant jet against mitral valve
mitral stenosis
describe
diastolic descrendo rumble due to turbulence thru stenotic valve
opening snap due to high LA pressure
mitral stenosis
auscult site
apex
tricupsid stenosis
diastolic descrendo rumble due to turbulence thru stenotic valve
opening snap due to high RA pressure
tricuspid stenosis
auscult site
left 4th iCS, lower sternal border
tricuspid stenosis
change with respiration
inspiration incr intensity
valsalva hemodynamic changes
decr LV preload
valsalva distinguishes what
aortic stenosis from HOCM
aortic stenosis soften
HOCM loud
squatting hemodynamic
return blood from leg to heart
incr LV preload, incr LV filling
squatting distinguish what
decr HOCM (displaces outflow obstruction)
