Common systolic murmurs
Aortic stenosis & Mitral Regurg/Insuff.
Common diastolic murmurs
Mitral stenosis & Aortic Regurg/Insuff.
7 qualities to describe a murmur
- Timing
- Intensity
- Shape
- Location
- Pitch
- Quality
- Radiation
Murmur Grade characteristics & when do you hear thrills?
I. Faint II. quiet but heard immediately III. moderately loud IV. loud V. hear with steth partly off chest VI. No steth needed ***Thrills associated with IV or >
Pitch descriptions & then quality
Pitch-high med low
Quality - blowing, harsh, rumbling, musical
What is stenosis?
Thickening or blocking of valve leaflets
Systolic murmur types and what is the etiology/anatomical cause with each?
Increased turbulence associated w/…
- Ejection murmur: flow across abnormal SL valve or narrowed outflow
ex: Aortic Stenosis - Holosys. Murmur: incompetent AV valve
ex: mitral reg/insuff
Mid systolic ejection murmurs:
- what is common “shape”
- when innocent
- physiolog. reasons
- Pathologic causes
- cresc/decresc
- innocent w/ children/young adults
- physio anemia, preg, fever, hyperthyr
- Patho: AS, hypertrophic CM, Pulmon Stenosis
Aortic stenosis causes
- Degenerative/Age>65
- Bicuspid valve (1% babies)
- Rheumatic
- Atherosclerosis
- Irradiation or collagen vascular disease
Symptoms of AS presenting
- Most asymptomatic
- 50% present with CHF
- 35% w/ angina
- 15% w/ syncope
Treatment of AS
- Asymptomatic: no competitive athletics, echo every 2-5 years
- Symptomatic: valve replacement for severe disease…symptomatic AS is lethal
Where is AS heard best and does it radiate?
-Heard best 2nd IC space on right chest and radiates to carotids
MC holosystolic murmur
Mitral regurg or insufficiency. Can also be tricuspid regurgitation or VSD
Mitral valve regurgitation/insufficiency cause
Primary - leaflet, annular, or chord/papillary abnormalities
Secondary - LV dilation, Ischemic heart disease, MVP, infectious endocarditis
Symptoms of mitral valve regurgitation/insufficiency
exercise intolerance palpitations angina dyspnea A-fib
where do you hear mitral valve regurgitation/insufficiency best and radiate
Apex
radiate to axilla/back or base of heart
***usually has systolic thrill, soft s3
Rumbling diastolic murmur vs. early decrescendo diastolic
mitral stenosis vs. aortic regurgitation
Mitral stenosis cause & main symptoms
Rheumatic fever & RHD
Palpitations, hoarseness from recurrent laryngeal nerve impingement, and a-fib
Mitral stenosis txt
- yearly echo
- BB or CCB to decrease HR and left atria pressure
- Valve replacement in severe disease
- A-fib therapy
MS: when in heart sounds, pitch, best heard, and radiation?
- mid diastolic
- low pitch
- Apex
- no radiation/little
Aortic Regurgitation: -where heard best what pitch shape when in heart cycle quality radiation
- 2nd/3rd ICS left sternum
- high pitch
- decrescendo
- early diastole
- blowing quality
- radiate to sternal boarder
Continuous murmurs:
- when do they start and end
- 3 common examples
-systole to all or part of diastole
-PDA - has harsh quality
Venus hum: abolished by compression over IJV or turning head
-Pericardial friction rub (scratchy)
PDA shape, timing and what is the ductus artery
- cres/decres
- both systole and diastole
- artery in fetus that connects pulmonary artery to aorta that usually collapses and then can fibrose
Left lateral position to auscultate for…
Mitral/Tricuspid murmurs
