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Updated: Oct 1 2021

Heart Murmurs

4.5

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Images
https://upload.medbullets.com/topic/108013/images/heartmurmurs-calcifiedaorticvalve.jpg
https://upload.medbullets.com/topic/108013/images/heartmurmurs1.jpg
https://upload.medbullets.com/topic/108013/images/082417vldstep1cardiacheartauscultation-moises edits.jpg
  • Auscultation Rules of Thumb
    • "All Physicians Take Money" (rule of thumb/mnemonic)
      • aortic valve
        • upper right sternal border
          • aortic stenosis
          • flow murmur
          • aortic valve sclerosis
      • left ventricular outflow tract obstruction
        • lateral displacement of maximal impulse
        • S4 gallop
        • upper left sternal border (ULSB) harsh, crescendo-decrescendo systolic murmur
          • hypertrophic obstructive cardiomyopathy
      • pulmonic valve
        • ULSB
          • pulmonic stenosis
          • flow murmur (e.g., ASD)
      • tricuspid valve
        • lower left sternal border (LLSB)
          • pansystolic murmur (tricuspid regurgitation and VSD)
          • diastolic murmur (tricuspid stenosis and ASD)
      • mitral valve
        • apex
          • systolic murmur (mitral regurgitation)
          • diastolic murmur (mitral stenosis)
      • Murmur Cheat Sheet
      • Crescendo/Decrescendo
      • Holosystolic
      • Systolic
      • AS (to neck)
      • MVP (click)
      • HOCM
      • MR (to axilla)
      • TR (inspiration increases)
      • VSD (harsh)
      • Diastolic
      • Aortic regurgitation
      • MS (opening snap)
    • NOTE: See chart below for abbreviations
  • Murmur Identification
      • Systolic
      • Lesion
      • Shape
      • Location Heard
      • Altered by
      • Characteristics
      • Aortic stenosis (AS)
      • Crescendo-decrescendo
      • Radiates to neck (carotids) and apex
      • --
      • "Parvus et tardus" (pulses weak compared to heart sounds)
      • Follows ejection click (due to halting of valve leaflets)
      • Hypertrophic cardiomyopathy (HOCM)
      • Crescendo-decrescendo
      • --
      • ↓ venous return (e.g.,Valsalva) - increases murmur
      • --
      • Mitral valve prolapse (MVP)
      • Late crescendo
      • --
      • ↑ TPR (e.g.,squatting, hand grip) - decreases murmur
      • ↓ venous return (e.g., Valsalva) - increases murmur
      • Mid-systolicclick (tensing of chordae tendinae)Loudest at S2Later with ↑ afterload (e.g., hand grip).
      • Mitral regurgitation (MR)
      • Holosystolic
      • Radiates to axilla
      • ↑ TPR (e.g., squatting, hand grip)
      • ↑ LA return (e.g.,expiration)
      • High-pitched, blowing
      • Tricuspid regurgitation (TR)
      • Holosystolic
      • Radiates to right sternal border
      • ↑ RA return (e.g.,inspiration)
      • High-pitched, blowing
      • Ventricular septal defect (VSD)
      • Holosystolic
      • --
      • --
      • Harsh-sounding
      • Diastolic
      • Lesion
      • Shape
      • Location Heard
      • Altered by
      • Characteristics
      • Aortic regurgitation (AR)
      • Early decrescendo
      • Left sternal border with patient leaning forward
      • --
      • High-pitched blowing heard at end of expiration
      • Mitral stenosis (MS)
      • Late rumble
      • Heard in lateral left decubitus position
      • ↑ LA return (e.g., expiration)
      • Opening snap (tensing of chordae tendinae) in early diastole after A2
      • Other
      • Lesion
      • Shape
      • Location Heard
      • Altered by
      • Characteristics
      • Patent ductus arteriosus (PDA)
      • Continuous
      • ULSB
      • --
      • Machine-like continuous/constant murmur heard through systole and diastole
      • Atrial septal defect (ASD)
      • Systolic and diastolic
      • Systolic: ULSB (pulmonic valve)
      • Diastolic: LLSB (tricuspid valve)
      • --
      • --
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