Jugular Venous Waveform
- Check for'double' waveforms (a&v)
- Check for big V waves (tricuspid regurgitation) and cannon waves suggesting AV dissociation.
Loud first heart sound
Loud with MS, hyperdynamic circulation (e.g. anaemia and short PR).
Second heart sound
Normally split and increased with inspiration, reversed with LBBB and other causes of delayed LV systole.
Added heart sounds
Third (mid-diastolic) common in young, pregnant, pathological in MR, LVF
Fourth (pre-systolic); HTN, isch, LVH
Clicks: relatively common, MV prolapse
- Many flow murmurs are innocent, particularly in children and pregnancy.
- Aortic sclerosis common in elderly and causes systolic murmur.
Aortic stenosis commonest cause for valve surgery. Systolic murmur radiating to carotids and best sign of significance is slow carotid upstroke.
Aortic regurgitation blowing decrescendo diastolic murmur.
Mitral incompetent (reguritant) murmur systolic. Classical teaching = pansystolic.
Pheumatic MR like that as is MR due to severe LV dilatation but common causes now are prolapse and papillary muscle dysfunction which cause late systolic murmurs.
Mitral stenosis (now very rare in Tasmania) has a rumbling mid diastolic murmur.
Mitral valve prolapse: systolic click and/or late systolic murmur.
Regurgitation best diagnosed by big V waves and pulsatile liver.
Stenosis is virtually never seen.
Hypertrophic obstructive cardiomyopathy (HCOM)
Systolic murmur varying with LV volume
Ventricular septal defec (VSD)
Loud pansystolic murmur
Atrial septal defect (ASD)
Fixed split second sound sometimes soft sysolic murmur.
Patent ductus arteriosus (PDA)
Loud continuous 'machinery' murmur