22 Heart Murmurs
- LSB: Erb's point, no specific for one valve, aortic regurge
- Apex: 5th intercostal space, mid clavicular line
- Apex: PMI. If not at mid clavicular: enlarged
- hyperdynamic: pushing very hard against finger, sympathetic driving
- laminar: slow rate, no murmurs
- turbulent: fast speed, very loud. Creates heart murmurs
- closer together: S1 - S2. Farther apart: S2 - S1
- in real life, 2 or 3
- on exam, maybe up to 4, 5
- hypertrophic cardiomyopathy: heart contracting, sound created by thick septum blood has to flow around
- VSD: blood pushed through a hole
- stills: heard in children, all normal murmurs
Aortic Stenosis
- crescendo-decrescendo: ejection
- pulsus parvus (weak) et tardus (late): put finger on pulse, sluggish/weak upstroke of carotid compared to normal vigorous pulse
Aortic Regurgitation
Mitral Regurgitation
Mitral Stenosis
- opening snap after S2, like S3, occurs because stiff mitral valve leaflets has to open in diastole, followed by holo diastolic murmur
- left sided S3/S4 both caused by rapid filling of ventricle, doesn't happen in stenosis
- more severe stenosis, quicker opening snap occur: LA pressure rises with severe stenosis. When very high, OS happen quicker
Tricuspid and Pulmonic
- inspiration: increased venous return to right side, right murmurs louder
- inspiration: dilate veins in lungs, drops venous return to left side of heart, quieter
- like sucking blood into lungs, pull blood away from left and pool in right
- pulmonic stenosis very rare
- tricuspid: very uncommon, occur in conjunction with mitral stenosis
- pregnancy: women with asymptomatic rheumatic heart disease become sympatomatic when blood volume goes up
- PHTN: high pressure in lungs push blood back through pulmonic valve
- tricuspid: first place seeds
- Mitral hat: Endocarditis: affects mitral valve; M protein molecular mimicry with muscle myosins. Mitral stenosis in conjunction with tricuspid stenosis
- Running camel and mortar/pestel: acute rapid onset tricuspid endocarditis in IV drug users
Carcinoid
- only if met to liver to not be metabolized
VSD
- loud murmur = sick people, severe problem, severe symptoms, HF
- very loud murmur and asymptomatic: rare, VSD (mitral, tricuspid regurg very sick with loud murmurs)
PDA
- continuous: blood flows through in all phases of cardiac cycle
Maneuvers
- inspire: diaphragm moves down, compresses veins in abdomen. Thorax also dilate
- inspire: dilate veins in lungs
- Tetralogy of fallot squat: increase afterload, feels better, different physiology
- MVP: mitral valve bellow up into LA (bottom pic) and snap up to cause mitral regurge.
- more preload: tightens leaflets, don't bellow quite as much, come together more firmly (top), less regurge
- HCM: thick septum gets in way of blood flowing out of LV = murmur
- more preload: septum pushed more towards right, less obstruction, less murmur
- amyl nitrate not used anymore
- AR, MR, VSD: blood flowing in wrong direction
- forward: harder for blood to flow in foward direction
- MVP, HCM: increased afterload increases LV cavity size, softer murmur
Backlinks
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Heart Murmurs
heart murmurs
Heart Murmurs
- General rules
- Most murmurs increase in sound with increase preload
- Forward murmurs (stenosis) decrease with increase afterload
- Backward murmurs (regurge, VSD) increase with increase afterload
- MVP, HCM decrease with increase preload or afterload
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