Heartsound Murmur.docx

MD Cheatsheet Heart Sound & Murmur Auscultation Location

S1

Loud S1  Mitral/Tricuspid Stenosis or Thickening  Hyperkinetic heart (Anemia, Thyroid heart disease)

Variable S1  AF  VT  AV Block  Pulsus Alternans Soft S1  LBBB  Calcified Mitral/Tricuspid  LV Failure  MR or AR

S2 – Normal Physiological Split when inspiration Wide Split  RBBB  PS  PE  CPC Fixed Split  ASD  VSD  RV Failure Paradoxical Split  LBBB  AS  TR  RA Myxoma Single  Emphysema  AS  PS

S3 sudden deceleration in

S4 atrial contraction to

left ventricular flow and tensing chorda tendinae

eject blood to stiff/High Pressure LV



 

Hyperkinetic Heart (Thyrotoxicosis, Anemia, Pregnancy) Increase Preload (VSD, AR, MR, PDA) CHF

  

Hypertension AS Coartaction Aorta

Non exist in AF

Systolic Extra Heart Sound  Valvular AS  Bicuspid Aortic  PH  MVP  Prostetic Valve  Pericardial Friction Rub

MS S1 Loud Diastolic Rumble in apex Disertai Opening Snap P2 mengeras bila ada PH

MR Holosystolic Murmur in apex radiating to axilla Systolic apical thrill Displaced apex to left S3 heard Intensed murmur with handgrip, squat, leg raise

MVP Mid-systolic click The clicks are believed to result from the sudden tensing of the mitral valve apparatus as the leaflets prolapse into the left atrium during systole.

Late systolic murmur ASD

HCM Harsh cresendodecrescendo systolic murmur intensed with Valsava and Amyryl Nitrate TR

Diastolic Extra Heart Sound  Opening Snap -Loud short snapping early diastolic sound produced by sudden tensing and deceleration blood flow thru stenotic (but Still mobile) AV Valve, predominantly anterior leaflet. Earlier OS, The Worse stenosis – RHD, MS

  

Gallop – CHF, HCM Tumor Plop - Myxoma Pericardial Knock – Restrictive Cardiomyopathy AS AR Systolic ejection murmur Diastolic murmur LSB radiated to neck while upward and Weakened Carotid leaning patient upstrokes Corrigan Pulse Pulsus parvus et tardus Durozies Sign Forceful apical beats Bobbing Head/ de Soft or lost A2 musset component Austin Flint Murmurdue to vibration of the mitral valve S4 caused by the impinging AR is a low-pitched diastolic rumble heard Increased murmur with toward the LV apex Squat, nitrat, leg raise PS

PR

PDA

VSD Murmur intensed with handgrip, squat, leg raise