Murmurs + Splitting Flashcards
Aortic stenosis
Pansystolic crescendo decrescendo murmur
Mitral/tricuspid regurgitation
Pansystolic blowing high-pitched regurgitant murmur
Mitral – radiate to axilla
Tricuspid – radiate to write sternal border
VSD
Pansystolic harsh sounding murmur
Mitral valve prolapse
Mid-late systolic click
Followed by
Crescendo murmur
Aortic regurgitation
Diastolic blowing high-pitched DECRESCENDO murmur
+
Austin Flint murmur
Pulmonary valve regurgitation
High-pitched blowing diastolic murmur
+
Graham steel murmur
Mitral stenosis
Opening snap
followed by
Diastolic rumble
PDA
Continuous Machine like murmur
ASD
Diastolic rumble – increased flow across tricuspid
Pulmonary flow murmur -⬆️ flow through pulmonic valve
Later: pulmonary artery dilates – >pulmonic regurgitation = louder diastolic murmur
Why doesn’t blood across the actual ASD not cause a murmur?
There is no pressure gradient
Explain normal splitting
Remember split = assoc with pulmonic valve delay
Inspiration – >intrathoracic pressure decreases – >
Venus return increased – >more volume @ right side – >
delayed pulmonic valve closure
Explain wide splitting
Pulmonic stenosis/RBBB –>
Delay RV ejection/emptying –>
Explain fixed splitting
ASD – >left to right shunt – >
more blood in RA + RV –>
increased flow through pulmonic valve
Inspiration/expression doesn’t make a difference
Explain paradoxical splitting
Aortic stenosis/LBBB – >delay LV emptying –>
P2 comes before delayed A2
@InspirationP2 closes later and moves closer to A2
I.e. in terms of the diagram P2 moves to the right closer to A2
Where are the aortic/Pulmonic/tricuspid/mitral areas
2 A P
3 E
4 T M
Aortic = 2nd IC space right sternal border Pulmonic = 2nd IC space left sternal border
Erbs point - third IC space left sternal border
Tricuspid = 5th IC space left sternal border Mitral = 5th IC space mid clavicular line
