Valves 1
Aortic Stenosis Best Heard
Heard over aortic area
Ejection sound at 2nd right intercostal border
Mitral Stenosis Best Heard?
-Apex w/ Bell.
Mitral Stenosis Causes?
-Often occurs w/ Mitral Regurgitation
-Rheumatic Fever
-Cardiac Infection
Pulmonic Stenosis Physical Exam Findings?
-Systolic (ejection) murmur.
-Diamond-shaped, medium-pitched, coarse.
-Usually w/ a thrill.
-S1 often followed w/ ejection click
-S2 often diminished, usually wide split.
-P2 soft or absent.
-S4 common in right ventricular hypertrophy
-Murmur may be prolonged & confused w/ ventricular septal defect.
Aortic Regurgitation best heard
-Heard w/ diaphram w/ pt sitting and leaning forward
-Austin-Flint murmur heard w/ bell.
-Ejection click heard in 2nd right ICS
Aortic Stenosis Cause?
-Congenital bicuspid valve (rather than tricuspid).
-Rheumatic Heart Disease.
-Atherosclerosis
*May be cause of sudden death in children and adolescents.
Mitral Regurgitation Causes?
-Rheumatic Fever
-Myocardial Infarction
-Myxoma (non-cancerous growth)
-Rupture of chordae
Aortic Stenosis Physical Exam Findings?
-Midsystolic (ejection) murmur.
-Medium pitched, coarse, diamond-shaped.
-Crescendo-Decrescendo.
-Radiates along left sternal border (sometimes Apex) and to carotid w/ palpable thrill.
-Apical thrusts shift down and left and is prolonged if left ventricular hypertrophy is also present.
Mitral Valve Prolaspe Best Heard?
-Apex/Lower left sternal border.
-Easily missed in supine position
-Also listen w/ patient upright.
Aortic Regurgitation Causes?
-Rheumatic Heart Disease.
-Aortic Diseases (Marfan Syndrome).
-Syphilis.
-Dissection/Cardiac Trauma.
-Ankylosing spondylitis.
Aortic Regurgitation Physical Exam Findings?
-Early diastolic, high-pitched, blowing, often w/ diamond-shaped midsystolic murmur. Sounds often not prominent.
-Duration varies w/ BP. Low-pitched, rumbling murmur at Apex common (Austin-Flint)
-In left ventricular hypertrophy, prominent prolonged apical pulse down and left.
-Wide pulse pressure. Water Hammer or Corrigan pulse is common in carotid, brachial and femoral arteries.
Mitral Regurgitation Physical Exam Findings
-Holosystolic, plateau-shaped intensity, high-pitch, harsh blowing quality, often quite loud and may obliterate S2.
-S3-S4 Gallop common in late disease.
-If mild, systolic murmur crescendos
-If severe, early systolic intensity decrescendos.
-Apical thrust more to left and down in ventricular hypertrophy.
Pulmonic Stenosis Best Heard?
-Heard over pulmonic area radiating to the left and into the neck.
-thrill in 2nd and 3rd left ICS's.
Mitral Valve Prolapse Causes?
-Valve is competent early in systole, but prolapses into atrium later in systolic.
-May become more severe, equaling a holosystolic murmur.
-Often concurrent w/ Pectus Excavatum.
Mitral Stenosis Physical Exam Findings?
-Low frequency diastolic rumbles.
-Does not radiate.
-Palpable thrill at apex in late diastole is common.
-Visible lift in right parasternal area if right ventricular hypertrophied.
-Arterial pulse amplitude decreased.
Mitral Regurgitation Best Heard?
-Apex
-Transmitted into left axilla.
Pulmonic Stenosis Causes?
-Almost always caused by a congenital defect.
Mitral Valve Prolapse Physical Exam Findings?
-Typically late systolic murmur preceded by midsystolic clicks.
-Both murmur and clicks highly variable in timing and intensity.