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
What effect does inspiration have on right heart sounds
Increase intensity of right heart sounds because of Venus return increase
What effect does handgrip/squat have on heart sounds
Increase intensity for MR, AR, VSD / AS
Decrease intensity for AS, HCM / HCM
Increase MVP murmur + Later onset of click
What effect does Valsalva and standing have on the heart sounds
Decreased Venus return
Decrease intensity of most murmurs
Increase intensity of HCM
Decrease MVP murmur + earlier onset of click
What do we here in the aortic area
Systolic murmurs:
Aortic stenosis
Flow murmur
Aortic valve sclerosis
What do here in the pulmonic area
Systolic ejection murmurs:
Pulmonic stenosis
Flow murmur
What do you hear in erbs point
Diastolic murmur = AR/PR
Systolic murmur = HCM
What do you hear in tricuspid area
Pansystolic murmur
Tricuspid regurgitation + VSD
Diastolic murmur
Tricuspid stenosis + ASD
What can you hear in mitral area
Systolic = mitral regurg
Diastolic = mitral stenosis
