Crescendo-decrescendo systolic ejection murmur (maybe with ejection click)
aortic stenosis
Holosystolic, high-pitched “blowing murmur”
Mitral/Tricuspid regurg
Midsystolic click followed by late systolic crescendo murmur
mitral valve prolapse (mid-systolic click is from sudden tensing of chordae tendineae)
Note: that an early systolic click is a sign of bicuspid aortic valve prior to stenosis
Holosystolic, harsh-sounding murmur. Loudest at tricuspid area.
VSD
High-pitched “blowing” early diastolic decrescendo murmur
aortic regurgitation
Diastolic opening snap followed by rumbling late diastolic murmur
mitral stenosis
Continuous machine-like murmur
PDA
Pulsus parvus et tardus is associated with:
aortic regurgitation (pulses are weak with delayed peak)
What symptoms is aortic stenosis assoc with:
SAD - syncope, angina, dyspnea on exertion
Radiates toward axilla
mitral regurg
Radiates towards right sternal border
tricuspid regurg
Most frequent valvular lesion
mitral prolapse
Myxomatous degeneration (Marfan or Ehlers-Danlos) causes:
mitral prolapse
Signs of aortic regurgitation
- hyperdynamic pulse
- head bobbing when severe
- Wide pulse pressure
Rheumatic fever usually causes:
Mitral stenosis (which can lead to LA dilation and compression of L. recurrent laryngeal nerve)
What indicates a more severe mitral stenosis?
- less time between S2 and opening snap = more severe
Note: LA pressure»_space; LV pressure during diastole
Radiates to carotids
aortic stenosis
Causes of aortic regurg:
- aortic root dilation
- bicuspid aortic valve (which also does stenosis)
- endocarditis
- rheumatic fever
Fixed splitting
ASD (from left-right shunt increases flow through pulmonic valve that delays closure)
What is an S3 sound? What does it indicate?
S3- early diastole from rapid ventricular filling
Assoc: increase filling pressure (mitral regurge, HF, dilated ventricles, normal in kids)
What is an S4 sound?
S4- late diastole (“atrial kick” from hitting stiff ventricle)
Assoc: hypertrophy (from HTN)
Order of valves closing in normal splitting and why this occurs
- aortic close
- pulmonic close (S2)
Increased venous returns during inspiration, increases RV filling and delays the P closing
Wide splitting causes
- delay in RV emptying/pulmonic valve closure
pulmonic stenosis, RBBB
Paradoxical splitting causes
- delay in aortic valve closure (P sound before A)
aortic stenosis, LBBB
Inspiration and flow in heart
increases in venous return to RA (thus increases right heart sounds)
Hand grip and flow in heart
increases in afterload
Valsalva and flow in heart
decreases preload (thus decreasing intensity of most murmurs except for HCM)
Standing up and flow in heart
decreases preload (like valsalva)
Rapid squatting
increases preload (venous return) and afterload
Systolic heart sounds
- A/P stenosis, M/T regurg, VSD, MVP
Diastolic heart sounds
- A/P regurg, M/T stenosis
Presystolic murmur (think opening snap and diastolic rumble) that disappears with a. fib
M/T stenosis
Systolic ejection murmur in HCM LVOT vs aortic stenosis
HCM LVOT murmur: increases when standing (less blood filling LV = more obstruction)
Aortic stenosis = standing decreases afterload and thus reduces murmur