22 Heart Murmurs
Last updated
Last updated
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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
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laminar: slow rate, no murmurs
turbulent: fast speed, very loud. Creates heart murmurs
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closer together: S1 - S2. Farther apart: S2 - S1
in real life, 2 or 3
on exam, maybe up to 4, 5
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hypertrophic cardiomyopathy: heart contracting, sound created by thick septum blood has to flow around
VSD: blood pushed through a hole
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stills: heard in children, all normal murmurs
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crescendo-decrescendo: ejection
pulsus parvus (weak) et tardus (late): put finger on pulse, sluggish/weak upstroke of carotid compared to normal vigorous pulse
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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
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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
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only if met to liver to not be metabolized
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loud murmur = sick people, severe problem, severe symptoms, HF
very loud murmur and asymptomatic: rare, VSD (mitral, tricuspid regurg very sick with loud murmurs)
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continuous: blood flows through in all phases of cardiac cycle
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inspire: diaphragm moves down, compresses veins in abdomen. Thorax also dilate
inspire: dilate veins in lungs
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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
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