Exam 2- Heart Murmur worksheet

Where do you hear mitral stenosis

Apex of the heart with patient in left lateral decubitus

What does a mitral stenosis sound like?

Diastolic, low frequency "rumble"

Describe mitral stenosis

Narrowed valve restricts blood flow causing forceful ejection of blood into ventricle

What causes mitral stenosis

Rheumatic fever or cardiac infection

Where do you hear aortic stenosis

Aortic area

What does an aortic stenosis sound like?

Midsystolic, medium pitch, coarse, diamond-shaped, crescendo decrescnedo

Description of aortic stenosis

Calcification of valve cusps restricts forward flow causing forceful ejection from ventricle into systemic circulation

Causes of aortic stenosis

Congenital bicuspid valve, rheumatic heart disease, atherosclerosis

Where do you hear sub aortic stenosis?

Apex of heart

Findings of subaortic stenosis

Murmur fills systole, medium pitch, coarse, thrill often palpable during systole at apex and right sternal boarder

Describe subaortic stenosis

Fibrous ring usually 1-4mm below aortic valve

Causes of subaortic stenosis

Fibrous ring below the aortic valve

Where do you hear pulmonic stenosis the best?

Pulmonic area, radiating to the left and into neck with a thrill in the second and third intercostal spaces

Findings of pulmonic stenosis

Systolic murmur, diamond shaped, medium pitch usually with thrill

Description of pulmonic stenosis

Valve restricts forward flow causing forceful ejection from ventricle into pulmonary circulation

Causes of pulmonic stenosis

Almost always congenital

Where can you hear tricuspid stenosis the best?

Tricuspid area

Findings of tricuspid stenosis

Diastolic rumble accentuated early and late in diastole, louder on inspiration

Diastolic thrill palpable over right ventricle

Description of tricuspid stenosis

Calcification of valve cusps restricts forward flow causing forceful ejection into ventricles

Usually seen with mitral stenosis, rarely occurs alone

Causes of tricuspid stenosis

Rheumatic heart disease, congenital defect, endocardia fibroblastosis, right atrial myxoma

Where do you hear mitral regurgitation best

Apex and transmitted into left axilla

Findings of mitral regurgitation

Systolic, high pitched, harsh blowing

Description of mitral regurgitation

Backflow through mitral valve from ventricle to atrium

Causes of mitral regurgitation

Rheumatic fever, myocardial infarction, myxoma, rupture of chordae

Where do you hear mitral valve prolapse best?

Apex and left lower sternal border

Easily missed in supine

Heard upright

Findings of mitral valve prolapse

Late systolic murmur, midsystolic clicks, both murmur and clicks highly variable in intensity and timing

Description of mitral valve prolapse

Valve is competent early in systole but prolapse into atrium later in systole

Causes of mitral valve prolapse

Concurrent with precuts excavatum

Where do you hear aortic regurgitation best?

Patient sitting and leaning forward

What is heard with aortic regurgitation?

Austin Flint murmur= murmur heard with bell, ejection click heard in 2nd intercostal space

Findings of aortic regurgitation

Early diastolic high pitch, blowing often with diamond shaped midsystolic murmur

Description of aortic regurgitation

Valve incompetence allows backflow from aorta to ventricle

Causes of aortic regurgitation

Rheumatic heart disease, endocarditis, aortic diseases (Marfan syndrome, medial necrosis)

Syphilis, ankylosing spondylitis, dissection, cardiac trauma

Findings of pulmonic regurgitation

Difficult to distinguish from aortic regurgitation

Description of pulmonic regurgitation

Valve incompetence allows backflow from pulmonary artery to ventricle

Causes of pulmonic regurgitation

Secondary to pulmonary hypertension or bacterial endocarditis

Where do you hear tricuspid regurgitation best?

Left lower sternum, occasionally radiating a few centimeters to left

Findings of tricuspid regurgitation

Holosystolic murmur over right ventricle, blowing increased on inspiration

S3 thrill over tricuspid area common

Description of tricuspid regurgitation

Valve incompetence allows backflow from ventricle to atrium

Causes of tricuspid regurgitation

Congenital defects, bacterial endocarditis (especially in IV drug abusesrs), pulmonary hypertension, cardiac trauma

Which murmurs are heard during diastolic?

Dead ARMS and PaRTS= Diastolic

Aortic Regurgitation

Mitral Stenosis

Pulmonic Regurgitation

Tricuspid Stenosis

Which murmurs are heard during systolic?

Mitral Regurgitation

Aortic/Subarotic Stenosis

Tricuspid Regurgitation

Pulmonic Stenosis

Mitral Valve Prolapse