Heart Murmurs Flashcards
Cause of wide split S2
Delay of RV emptying b/c aortic closes after pulmonic
Heard more on inspo
Pulm stenosis
Cause of fixed split S2
ASD
P2 is delayed the same in inspo + expo because constant volume overload in the R heart
Cause of paradoxical splitting
Anything that delays aortic valve closure - hear pulmonic closing before aortic
Split gets eliminated on expo b/c P2 moves closer to A2
**Aortic stenosis
Systolic C/D murmur
At base
Aortic stenosis - only C/D murmur
Radiates to carotids
Pulsus parvus et tardus
Holosystolic blowing murmur (2) vs harsh sounding murmur (1)
Blowing
1. Mitral regurg if @ apex
2. Tricuspid regurg if @ L sternal border
Harsh = VSD @ L sternal border
Mid systolic click followed by late systolic crescendo murmur at apex
Mitral valve prolapse
Early diastolic blowing murmur
Aortic regurg
Head bobbing, hyper dynamic pulse, wide PP
“Sit up + lean forward, hold breath at end of expiration”
S2 then OS + delayed rumbling late diastolic murmur
Mitral stenosis
What indicates the severity of mitral stenosis via murmur
How close S2 and OS are b/c indicates rising pressuring in the RA
Describe PDA murmur
Continuous through systolic + diastolic
Machine like - loudest @ S2
Which murmurs are louder on inspiration
R heart b/c increase intra-thoracic P = more venous return to R
What does hand grip do? Which murmur are more (3) and less intense (1) with this maneuver?
Increases after load (peripheral vasoconstriction) Louder: 1. MR 2. AR 3. VSD Softer: hypertrophic CM
Name the ways you move MVP click: 2 ways to move it later in diastole, 1 way earlier
Later 1. Rapid squat 2. Hand grip Earlier 1. Valsalva // standing up
How do most murmurs change with valsalva//standing up? Hypertrophic CM?
Decrease preload
Decrease HCM
Increase most others
How does rapid squat change HCM vs AS murmur?
Increasing venous return -> preload, AND increasing after load
Less intense HCM
More intense AS
