Murmurs and Severe Clinical Signs



Cardiac Lesions and Severe Clinical Signs

15/11/10

Talley and O’Connor

AORTIC STENOSIS

Slow rising pulse

S4

Paradoxical splitting of the second heart sound

Aortic thrill

Length and harshness of murmur

LVH – displaced apex beat

LVF – a late sign

MITRAL STENOSIS

Small pulse pressure

Soft first heart sound

Early opening snap

Long diastolic murmur

Diastolic thrill @ apex

PHT signs

MITRAL REGURGITATION

Small volume pulse

Displaced forceful apex

Pansystolic murmur -> axilla

S3

Soft S1

A2 early

Early diastolic rumble

AF

LVF signs

AORTIC REGURGITATION

Collapsing pulse

Wide pulse pressure

Long decrescendo diastolic murmur

S3

Soft A2

Austin-Flint murmur (low pitched rumbling mid-diastolic and presystolic murmur @ apex)

LVF

MITRAL VALVE PROLAPSE

Click -> high pitched late-systolic murmur extending throughout systole

TRICUSPID REGURGITATION

JVP: Large v-waves, elevated

Right ventricular heave

Pansystolic murmur @ the lower sternal edge (increases with inspiration)

Large, pulsatile liver

Ascites

Peripheral oedema

PULMONARY STENOSIS

Ejection systolic murmur peaking late in systole

Absent ejection click

S4

RVF signs

ASD

- wide fixed splitting of S2

- mid diastolic flow murmur over tricuspid area (when significant shunt present)

VSD

- harsh pansystolic murmur @ left sternal edge

- systolic thrill

- mid diastolic flow murmur over mitral area (when significant shunt present)

PATENT DUCTUS ARTERIOSUS

- continuous murmur over pulmonary area

- mid diastolic flow murmur over mitral area (when significant shunt present)

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