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Cardiac Auscultation

 Systolic Murmurs Aortic regurgitation:


 Aortic or Pulmonic STENOSIS  Not as common
 Mitral or Tricuspid REGURG  Early Diastolic Murmur (decrescendo)
 Diastolic Murmurs  Associated systolic flow murmur
 Mitral or Tricuspid STENOSIS  Associated sign:
 Aortic or Pulmonic REGURG  Collapsing pulse
 Consider Marfans
Aortic stenosis:
 Very common…especially with age
 Crescendo – decrescendo murmur
 “Diamond shaped”
 Ejection click
 Many signs:
 Pulsus parvus et tardus
 Radiation up carotids
 Soft/absent A2 sound

Mitral regurgitation:
 Common
 Holo-systolic murmur
 Radiation to axilla
 Patients may develop heart failure,
dyspnea

Acute mitral regurgitation:


 Occurs in the setting of MI
 usually a few days after a left
sided MI
 Due to acute papillary muscle rupture
 Dx: NEW holosystolic murmur
 Is an emergency!
 Cardiovascular collapse & shock
 Need urgent surgery
Cardiac Auscultation

Mitral prolapse: Other sounds:


 Valve leaflets balloon back into the left  Continuous murmur…loud, “machine”
atrium (prolapse)…like a parachute like à Patent Ductus Arteriosus
 Due to “myxomatous” degeneration of (children)
valves  Rub
 Over time, mitral regurg can develop  Pericardial Friction Rub
 Auscultation  High pitched scratchy noise
 Mid-systolic Click à Pericarditis

Special manuevers:
 Inspiration
 Right sided murmurs become
louder
 Expiration
 Left sided murmurs become
louder
 Left Lateral Position
 Mitral murmurs
 Hand grip, squatting à Increased PVR
Pediatric murmurs:  AS à SOFTER murmur
 Right sided murmurs are more common  MR à LOUDER murmur
in kids…eg. Tricuspid murmurs
 Holosystolic murmur in a child
 Likely a ventricular septal defect
(Not mitral regurg)

Mitral stenosis:
 Used to be common….less common now
 Leading cause = rheumatic fever
 Less common now
 Diastolic murmur
 May be opening snap
 Loud S1

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