mitral stenosis
aortic regurg
Systolic murmurs
MR (MVP), TR
AS, PS, VSD
Aortopulmonary shunts: (early, mid, late, holosystolic/ pansystolic)
diastolic murmurs
Diastolic – AR, PR - MS, TS
Atrial myxoma
Pathophysiology AS•
Pathophysiology AS
Obstruction leads to pessure overload; LVH, increase LVED pressure
Gradientacrossvalve
• Severe AS if A oV<1.0cm2
harsh systolic murmur in 2nd intercostal space that radiates into supra sternal notch/carotids
AS
Gallavardin phenomenon
AS: means the AS murmur radiates to the apex like MR (imitates an MR)
AS, severe
TR
TR: V wave. Carvallo sign - murmur at LSB inc. w/ inspiration.
ass w/ pulmonary HTN, inferior MI,
blowing murmur at LSB inc. w/ inspiration.
systolic murmur, carvello sign of TR
decrescendo/crescendo murmur (“u” shape)
MS and TS, diastolic murmurs
decrescendo murmur
PR and AR
AR: 3rd ICS LSB. Bunch of signs.
PR: Graham Steell.
3rd ICS LSB, descescendo murmur
AR
AR: 3rd ICS LSB. Bunch of signs.
PR: Graham Steell.
TS
Tricuspid Stenosis (TS)
Associated with MS, TR and RHD
Pathophysiology: Prominent “A” wave in
JVP ascites, hepatomegalia (may pulsate)
Diastolic murmur LSB; increase with inspiration (Carvallo’s sign) and decrease with expiration and valsalva.
blowing murmur 2 SB
Pulmonic Regurgitation (PR or PI)
- Most cases are due to pulmonary HTN
- Diastolic, blowin gmurmur 2 SB (Graham Steell)
systolic murmur and ejection click, radiates toward left shoulder and increases on RVH
Can cause angina and syncope
- Auscultation – systolic murmur, ejection click
- 2nd – 3rd ICS, LSB/radiates toward left shoulder and increases on inspiration/RVH
- Maybe associate with TOF or TGA
- May require balloon commissurotomy if pressure gradient > 50mmHg
hoarse voice, trouble breathing while laying down
MS
DOE, cough orthopnea, PND, pulmonary
edema, hemoptysis, arterial emboli, A. fib
Ortner syndrome: hoarseness d/+ compression of left recurrent laryngeal nerve
“A” wave vs “V” wave
TS: Prominent “A” wave in JVP, ascites, hepatomegalia (may pulsate)
TR: Prominant “U” wave in JVP
Malar flush – ruddy cheeks, blue facies. Increase S1; opening shape (OS) after S2
Rumbling, low pitched; best heard at apex. Use bell.
MS
Exertional dyspnea, angina, syncope, heart failure
AS
Exertional dyspnea, angina, syncope, heart failure
- Without treatment prognosis is poor
- Without treatment most will die within three years of developing syncope and within two years of onset of HF.
Parvus/Tarvus, narrow pulse pressure
AS
1) a crescendo-descendo vs 2) a click –> cresendo-decrescendo
2) pulmonary stenosis
1) AS
AS
PS
