PE Cardiovascular - Abnormal heart sounds

Systolic Murmors

Mitral regurgitation

Tricuspid regurgitation

Aortic stenosis

Pulmonary stenosis

Diastolic Murmurs

Mitral stenosis

Tricuspid stenosis

Aortic regurgitation

Pulmonary regurgitation

Mitral Stenosis

Timing - Mid diastolic with opening snap

Loudest point - limited to apex

Special maneuver - heard best using the bell with the patient in left lateral decubitus position

Mitral Regurgitation

Timing - holosystolic (throughout the entire systolic phase)

Loudest point - Apex

Radiation - Left axilla

Special maneuver - left lateral decubitus position

Pulmonic Stenosis

Timing - Mid-systolic

Amplitude - soft to loud with a thrill

Loudest point - 2nd and 3rd intercostal space

Radiation - left shoulder and neck

Tricuspid Stenosis

Timing - mid-diastolic

Loudest point - 2nd and 3rd left intercostal space

Pericardial Friction rub

Timing - one systolic and two diastolic

Quality - Squeaky, grating, scratching, or rasping

Aortic Regurgitation

Timing - early diastolic

Loudest point 2nd to 4th intercostal spaces

Special maneuver - heard best with the patient sitting, leaning forward and holding breath in full expiration or with isometric exercises

Pulmonic Regurgitation

Timing - early diastole

Loudest point - left sternal border (pulmonic area)

Special test - heard better during inspiration with pt standing

Mitral Valve prolase

Timing - Mid systolic click with late systolic murmer (Only significant late systolic murmur)

Loudest point - Apex

Special maneuver - accentuated by having the patient valsalva

Tricuspid Regurgitation

Timing - Holosystolic

Amplitude - Varies with breathing

Loudest point - left 4th intercostal space

Special maneuver - the murmur increases with inspiration and decreases with expiration

Hypertrophic Cardiomyopathy

Timing - Holosystolic S4

Loudest point - Apex, 3rd and 4th left intercostal space

Radiation - To base of heart or axilla

Special maneuver - Squatting decreases, valsalva increases

Aortic stenosis

Timing - Holosystolic

Loudest point - Right 2nd intercostal space

Radiation - Carotids

Other features - Delayed carotid upstroke, ejection clicks

Patent Ductus Arteriosus

Holosystolic, extends into diastole

Quality - Harsh, machinery like sound

Loudest - left 2nd intercostal space

Radiation - left clavicle

Special maneuver - PMI is laterally displaced; a thrill may be present in the suprasternal notch

Ventricular septal defect

Timing - holosystolic

Amplitude - very loud

Loudest - Left 3rd to 5th intercostal space

Radiation - Right lower sternal border

Special maneuver - does not intensify with inspiration

Murmurs that radiate up

Systolic

Mitral regurgitation - Axilla

Aortic stenosis - Carotids (Mostly right)

Murmurs that radiate down

Diastolic

Aortic regurgitation - Apex

Pulmonary regurgitation - Xiphoid