Cardiac Murmurs Flashcards
(12 cards)
Aortic Stenosis (AS)
Site: Right 2nd ICS<br></br>
Character: Harsh, crescendo–decrescendo<br></br>
Radiation: To carotids (especially right)<br></br>
Timing: Systolic ejection<br></br>
Pitch: Medium<br></br>
Symptoms: Syncope, angina, dyspnea<br></br>
Predisposing Factors: Aging (calcific), bicuspid valve, rheumatic fever<br></br>
Scenario: Elderly male with exertional chest pain and syncope
Aortic Regurgitation (AR)
Site: Left 3rd ICS (Erb’s point)<br></br>
Character: Blowing, decrescendo<br></br>
Radiation: Left sternal border<br></br>
Timing: Early diastolic<br></br>
Pitch: High<br></br>
Symptoms: Palpitations, dyspnea, bounding pulses<br></br>
Predisposing Factors: Endocarditis, rheumatic fever, Marfan syndrome<br></br>
Scenario: Tall young man with Marfan features and wide pulse pressure
Mitral Stenosis (MS)
Site: Apex (5th ICS MCL)<br></br>
Character: Low-pitched diastolic rumble<br></br>
Radiation: None<br></br>
Timing: Mid-diastolic with presystolic accentuation<br></br>
Pitch: Low<br></br>
Symptoms: Dyspnea, orthopnea, AFib<br></br>
Predisposing Factors: Rheumatic fever<br></br>
Scenario: Middle-aged woman from developing country with progressive dyspnea and AFib
Mitral Regurgitation (MR)
Site: Apex<br></br>
Character: Blowing, holosystolic<br></br>
Radiation: To axilla or back<br></br>
Timing: Holosystolic<br></br>
Pitch: High<br></br>
Symptoms: Fatigue, dyspnea, palpitations<br></br>
Predisposing Factors: MVP, rheumatic disease, post-MI<br></br>
Scenario: Post-MI patient with acute pulmonary edema and pansystolic murmur
Mitral Valve Prolapse (MVP)
Site: Apex<br></br>
Character: Mid-systolic click with late systolic murmur<br></br>
Radiation: Variable<br></br>
Timing: Late systolic<br></br>
Pitch: Medium to high<br></br>
Symptoms: Palpitations, chest pain, anxiety<br></br>
Predisposing Factors: Young females, Marfan/Ehlers-Danlos<br></br>
Scenario: Young woman with midsystolic click, murmur ↑ with Valsalva
Tricuspid Regurgitation (TR)
Site: Left lower sternal border<br></br>
Character: Blowing<br></br>
Radiation: Right lower sternal border<br></br>
Timing: Holosystolic<br></br>
Pitch: Medium<br></br>
Symptoms: Ascites, edema, fatigue<br></br>
Predisposing Factors: Pulmonary hypertension, RV dilation, IV drug use<br></br>
Scenario: IV drug user with fever and hepatomegaly
Tricuspid Stenosis (TS)
Site: Lower left sternal border<br></br>
Character: Rumbling<br></br>
Radiation: None<br></br>
Timing: Mid-diastolic<br></br>
Pitch: Low<br></br>
Symptoms: Fatigue, ascites, hepatomegaly<br></br>
Predisposing Factors: Rheumatic fever<br></br>
Scenario: Woman with rheumatic history and right heart failure
Pulmonary Stenosis (PS)
Site: Left 2nd ICS<br></br>
Character: Harsh<br></br>
Radiation: Left shoulder/neck<br></br>
Timing: Systolic ejection<br></br>
Pitch: Medium<br></br>
Symptoms: Cyanosis, fatigue, exertional dyspnea<br></br>
Predisposing Factors: Congenital heart disease<br></br>
Scenario: Cyanotic infant with loud systolic murmur
Pulmonary Regurgitation (PR)
Site: Left upper sternal border<br></br>
Character: Blowing<br></br>
Radiation: None<br></br>
Timing: Early diastolic<br></br>
Pitch: High<br></br>
Symptoms: Dyspnea, fatigue, RHF signs<br></br>
Predisposing Factors: Pulmonary hypertension, repaired TOF<br></br>
Scenario: Adult with repaired congenital defect and RV overload
Ventricular Septal Defect (VSD)
Site: Left lower sternal border<br></br>
Character: Harsh, holosystolic<br></br>
Radiation: Across precordium<br></br>
Timing: Holosystolic<br></br>
Pitch: High<br></br>
Symptoms: CHF in infants, failure to thrive<br></br>
Predisposing Factors: Congenital, post-MI (rare)<br></br>
Scenario: Infant with poor feeding, tachypnea, loud murmur
Patent Ductus Arteriosus (PDA)
Site: Left 2nd ICS, infraclavicular<br></br>
Character: Continuous “machinery” murmur<br></br>
Radiation: To back<br></br>
Timing: Continuous (systole & diastole)<br></br>
Pitch: High<br></br>
Symptoms: Bounding pulses, failure to thrive<br></br>
Predisposing Factors: Prematurity, congenital rubella<br></br>
Scenario: Preterm infant with wide pulse pressure and continuous murmur
Hypertrophic Cardiomyopathy (HCM)
Site: Left sternal border/apex<br></br>
Character: Harsh<br></br>
Radiation: None<br></br>
Timing: Systolic ejection<br></br>
Pitch: Medium<br></br>
Symptoms: Syncope, chest pain, sudden death<br></br>
Predisposing Factors: Genetic (AD), family history<br></br>
Scenario: Young athlete collapses during exertion; murmur ↑ with Valsalva
