Approach to Cardiac Murmurs Flashcards
(24 cards)
PMI
- PMI>2.5 cm evidence of LV hypertrophy from HT or Aortic stenosis
- Displacement lateral midclavicular line: LVH, MI, HF
- IN pt with COPD, PMI on xiphoid or epigastric area bc of RV hypertrophy
Heart Sounds
S1: closure of the MV (LV P>LA P) S2: closure of AV (LV Pventricle)
Split S2
- Wide Physiological Splitting: increase in usual split during inspiration caused by delay closing of PV or premature closing of AV
- Fixed splitting: doesn’t vary with respiration
- prolonged RV systole in Atrial septal defect or RV failure
- Reversed Splitting: appears on expiration and disappears in inspiration
- close of AV delayed so A2 follows P2 in expiration, and normal inspiratory delay of P2 makes the split disappear: caused by Left bundle branch block `
Early Systolic Ejection Sounds
- after S1 bc of halting AV and PV as they open –> CVD -aortic ejection: both at base and apex-> dilated aorta, aortic valve disease, bicuspid aortic valve
- pulmonic ejection: 2nd and 3rd L ICS, S1 appears loud (should be soft), intensity decreased with inspiration–> dilation of pulm a, pulmon HT, pulmonic stensosis
Systolic Clicks
- mitral valve prolapse: systolic ballooning of MV into LA
- Squatting: delays click and murmur due to increased venous return
- Standing: moves clicks closer to S1
- usually at apex but also at lower left sternal border, high-pitched
- followed by late systolic murmur from mitral regurg that crescendos up to S2
Opening Snap
- very early diastolic sound caused by abrupt deceleration during opening of a stenotic MV
- heard medial to apex and along lower left sternal border high pitch snapping quality
- right after S2
S3
- high LV filling pressures and abrupt deceleration of inflow across MV at end of rapid filling phase of diastole
- decreased myocardial contractility, heart failure, L-R shunts, ventricular vol overload
S4
heard just before S1
-include hypertensive heart disease, aortic stenosis, ischemic and hypertrophic cardiomyopathy
Systolic Murmurs
- aortic stenosis or sclerosis
- Benign tumor
- hypertrophic cardiomyopathy
- ventral septal defect
- tricuspid regurg
- MV prolapse
- Mitral insufficiency
Diastolic Murmurs
- Right Upper or Left Midsternal Border: Aortic Insufficiency
- Left Upper sternal border: Pulmonic regurg
- Right Lower Sternal Border: Mitral stenosis
- Left lower sternal border: Tricuspid Stenosis
Systolic Murmur Types
- Midsystolic: begins after S1 stops before S2, brief gaps between murmur or heart sounds
- Pansystolic: starts with S1 and stops at S2 without a gap between murmur and heart sounds
- Late Systolic Murmur: usually starts in mid or late systole and persists up to S2
Diastolic Murmur Types
- Early: starts immediately after S2 without gap and fades into silence before next S1
- Middiastolic: starts shortly after S2, may fade away or merge into late diastolic murmur
- Late diastolic: starts late in diastole and typically continues up to S1
Continuous Murmur
begins in systole and extends into all or part of diastole
Crescendo/Decresendo Murmur
Crescendo: grows louder Decrescendo: grows softer Crescendo-Decrescendo: first rises in intensity, then falls Plateau: same intensity throughout
Aortic Stenosis Murmur
-medium harsh, cresendo-decrescendo -Right 2nd and 3rd IC -Grade 4/6 or above
Hypertrophic Cardiomyopathy Murmur
-Left 3rd and 4th ICS -Medium Pitch -Intensity decreased with squatting
Pulmonic Stenosis Murmur
- Left 2nd and 3rd ICS
- Soft to loud
-Medium cresendo-decresendo
Mitral Regurgitation
- Apex
- Soft to loud
- Medium to high
- Harsh holosystolic
- between S1 and S2
- intensity doesnt change with inspiration
Tricuspid Regurg
- Lower left sternal border
- Variable intensity
- medium pitch
- blowing, holosystolic
- intensity increases with inspiration
Ventricular Septal defect Murmur
- Left 3rd, 4th, 5th ICS
- Vry loud, with a thrill
- HIgh pitch, holosystolic
Aortic Regurge Murmur
- Left 2nd and 4th ICS
- Grade 1-3
- High pitch
- Blowing decresendo
- Best heard with pt sitting and leaning forward
Mitral Stenosis Murmur
- Limited to apex
- Descresendo low pitch rumnle with presystolic accentuation
- Listen with bell and turn pt to Lateral recumbent
Maneuvers to ID Systolic murmurs
Squatting (increase vasc tone and LV vol):
MV Valve prolapse: decrease, delay of click ,murmur shorten
Hypertrophic Cardiomyopath: decrease intensity and outflow obstruction
Aortic Stenosis: increase blood vol & intensity
Standing (decrease vasc tone and LV vol):
MV Valve prolapse: increase prolapse, click moves earlier in systole and murmur lengthens
Hypertrophic Cardiomyopath: Increase intensity and outflow obstruction
Aortic Stenosis: decrease blood vol & intensity
Aortic Stenosis: increase blood vol & intensity
