Systolic Murmurs
Best heart 2nd intercostal parasternal
"crescendo-decrescendo" "harsh/rough" murmur
Commonly due to rheumatic heart disease.
Mitral stenosis
SA and AV node switch, regular rhythm
Differently p morphology (almost in every beat)
60-100 bpm
Normal in children
Wandering Atrial Pacemaker
Healthy in young and athletic hearts, can be associated with HF
S3
3 pan systolic murmurs mentioned in Pearls ppt
1. Ventral septal defect
2. Mitral regurgitations
3. Tricuspid regurgitation
( we need 3 PANS To Make reg. Vanilla)
Radiates from the apex to the axilla
Late in disease causes JVD, hepatomegaly
MITRAL VALVE REGURGITATION
Best heard when leaning forward, causes bounding pulse , wide pulse pressure
Aortic regurgitation
PR interval constant -> QRS dropped
Can be regular/irregular
Second degree type II
Standing/Vasalva ___ venous return to the heart, ____ all murmurs except HOCM and MVP.
DECREASES
HOCM and MVP - get louder
Continuous machinery murmurs (2)
1. Patent ductus arteriosus
2. AV fistula
(Machinery - Pt at work DUCTs throws FIST)
Located upper left sternal border 2nd intercostal
PULMONIC STENOSIS
Best heard at apex, left lateral decubitus position with bell, S1 with opening snap then mid-diastolic rumbling murmur
Mitral Stenosis
Saw tooth appearance
Rate 250-350
A flutter
_____ increases venous return to heart, _____ all murmurs except HOCM and MVP.
Squatting/leg raises
increases
Inhalation increases __ side murmurs
Expiration increases __ side murmurs
RIGHT
Left - (Ex in expiration = exit = they LEFT)
What physiologic changes happen to the heart with MR?
Dilation - can lead to A fib
R side involvement - A flutter
Aortic regurgitation and ___ are both heard in left sternal border 2nd intercostal.
Pulmonic regurgitation
Rate 40-60
P waves can be present, hidden or right next to QRS
Can be lethal
QRS normal
Junctional Escape rhythm
Only difference between this rhythm and accelerated junctional (60-100) and junctional tachycardia (100-180) is heart rate.
Loud, associated with a thrill.
What grade is this?
4/6
Atrial kick against a stiff wall, hypertrophy or scar.
S4
Late systolic crescendo with a mid systolic click
Mitral valve prolapse
Known as Graham Steel murmur
Pulmonic Regurgitation
Heart rate 20-40
Absent p waves
WIDE QRS
Idioventricular Rhythm
Decreases AS murmur and increases AR and MR murmur
Decreases HOCM and MVP
hand gripping/phenylephrine
(increased total peripheral resistance)
Coarctation murmur best heard at
UNDER LEFT CLAVICLE where you would normally listen to patent ductus arteriosus