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Mitral Regurgitation (at least indicate murmur type, best heard location and radiation)
1. Holosysolic, high-pitched "blowing" murmur
2. Loudest at cardiac apex
3. Radiates towards axilla or clavicular area (depending on leaftlet involved)
4. Acute cases usu. due to endocarditis (most often S. aureus) or papillary muscle rupture
5. Chronic cases usu. due to rheumatic fever, Marfan''s syndrome and cardiomyopathy
NOTE: MVP is the most common cause of mitral regurgitation.
Tricuspid Regurgitation (at least indicate murmur type, best heard location and radiation)
1. Holosysolic, high-pitched "blowing" murmur
2. Loudest at tricuspid area
3. Radiates towards the RSB
4. Seen in IVDAs
VSD (at least indicate murmur type, best heard location and radiation)
1. Holosystolic, harsh-sounding murmur
2. Loudest at tricuspid area (left, lower sternal border)
Mitral valve prolapse (MVP) (at least indicate murmur type, best heard location and radiation)
1. Late systolic murmur with midsystolic click (MC)
2. Loudest at S2
3. Most common valvular lesion
NOTE: MVP is the most common cause of mitral regurgitation.
Aortic regurgitation (at least indicate murmur type, best heard location and radiation)
1. High-pitched "blowing" diastolic murmur (diastolic decrescendo murmur)
2. Murmur loudest at the 2nd left intercostal space
3. Wide pulse pressure (e.g BP 100/52)
4. Louder on sitting up, leaning forward and holding exhalation
5. MCC in developed countries is aortic root dilatation or bicuspid aortic valve; in developing countries, MCC is rheumatic heart disease.
6. Characteristic "water hammer pulse".
Mitral valve stenosis (at least indicate murmur type, best heard location and radiation)
1. Delayed rumbling diastolic murmur
2. Follows "opening snap"
3. Loudest at S2
4. Louder on left lateral decubitus
5. Almost all cases are due to rheumatic heart disease
Aortic valve stenosis (at least indicate murmur type, best heard location and radiation)
1. Harsh crescendo-decrescendo systolic ejection murmur
2. Follows an "Ejection Click"
3. Radiates to carotids and/or apex
4. "Pulsus parvus et tardus" (slow & delayed carotid upstroke)
5. Louder on sitting up, leaning forward and holding exhalation
6. Squatting and standing increase intensity
7. Decreased intensity with vasalva maneuver
PDA (at least indicate murmur type, best heard location and radiation)
1. Continuous machine-like murmur
2. Loudest at S2
What effect does STANDING, VALSALVA & LEG RAISE have on murmurs?
Standing, valsalva and leg raise DECREASE all murmurs but INCREASE the intensity of MVP and HCM
What effect does SQUATTING have on murmurs?
Squatting INCREASES all murmurs but DECREASES MVP and HCM
What effect does sustained hand grip have on murmurs?
SHG:
Increases MVP
Decreases HCM
My Own Observations
1. All "regurgitant" murmurs are "blowing" murmurs
2. VSD and murmurs involving the mitral and tricuspid valves defects are systolic murmurs because these valves should be closed shot during systole but are NOT (so the murmurs are accentuated during systole).
3. Aortic regurgitation is diastolic because the aortic valve can only become regurgitant during diastole (when the ventricles are resting and pressure is higher in the aorta)
4. Mitral stenosis is a diastolic murmur because it should open during diastole but it doesn't because it is stenotic.
5. Mitral Valve Prolapse is usu. due to papillary muscle prolapse (and it is the MCC of mitral regurgitation).
6. MCC of mitral valve stenosis is rheumatic heart dz (maybe because bacteria got on the valves, scarred it and made it stenotic?)
What is the classic description of a murmur of HCM?
Murmur at the left sternal border that decreases in intensity from a standing to a supine position. Usu. seen in young African-Americans.
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