mjl1717
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Describe the type and location of the murmur in Aortic and Mitral Stenosis,
Aortic and Mitral Regurg,and Pulmonic Stenosis
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| IMGPK
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Rules for murmurs:
1) Stenosis cause problem in opening and Regurge cause problem in closing
2) Systole= AV/PV open and MV/TV close (so systolic murmurs will come from AV/PV st. and MV/TV regurg)
3) Diastole= MV/TV open and AV/PV close (so diastolic murmurs will come from MV/TV St. and AV/PV regurg)
4) All murmurs best heard at respective valve areas.
Aortic Valve:
2nd ICS left St. border (A1) or right st. border (A2)
AS = Ejection Systolic radiating to neck (crescendo-decrescendo type)
AR = Early diastolic
Mitral Valve:
Apex, 5th ICS mid. clav. line
MS = Mid-Diastolic, rad. to axilla
MR = Pan-systolic
Pulm. Valve:
PS = Systolic murmur at left st. border 2nd and 3rd ICS
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| mjl1717
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IMGPK-I agree with most of what you say.
Just want to emphasize.
Aortic valve sound is most commonly at at the R 2nd interspace but can be at the L 3rd interspace.
During S1 we here closing of the AV valves (mostly mitral)
During S2 we hear closing of the semilunar valves (mostly Aortic)
S3 is in kids and adults with thin chest walls heard best at begining of expiration
S4 is almost never heard because of its low frquency 20cps or less.
**Aortic stenosis- mid systolic ejection murmur, cresendo diminuendo,
diamond shaped, radiates to the neck,down L. sternal border,
sometimes to the apex, a thrill, maybe pulses bisferiens, harsh, seagull
murmur,medium pitch. Concentric hypertrophy due to pressure
**Pulmonic stenosis.-mid systolic murmur with diamond shape,radiates to
carotids esp. on the left. thrill ,medium pitch, harsh, ejection click ,
widely split S2,ejection murmur (mid systolic ejection murmur)
Diastolic murmurs usually suggest disease.
**Mitral regurg.-pansystolic murmur heard at the apex,radiates to the
L. axilla, L sternal border and base,high pitch and blowing,assoc. with
S3,S4, assoc. with a "ventricular knock",decreased S1.
**Tricuspid Regurg-pansystolic murmur at the lower left sternal border
may radiate to right of sternum or L midclavicular line,but NOT the
axilla,high pitch and blowing,sometimes pulsations in the jugular and
liver.
**Mitral Stenosis-diastolic rumbling murmur,opening snap,very little
radiation, low pitch, left lateral decubitus,loudest in protodiastole
and presystole. may resemble the roll of a drum.,better heard with the
bell. (low rumble) heard ar apex ,increased S1
**Aortic regurg-ironically usually heard at 3rd left interspace,decrescendo
diastolic murmur,radiates to R2nd interspace down L.sternal border to
apex possibly to theR.sternal border. high pitch (use diaphragm)
and blowing.( Austin Flint resembles mitral stenosis) wide pule pressure
S3, large bounding pulses, Corrigan Pulse, (blowing early diastolic
murmur after S2) eccentric hypertrophy is due to volume, eg.HTN,
Rheumatic heart ds., Inf. endocarditis.
:idea:
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