Heart Murmurs Part 1


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May 02 2018 22 mins   17
During this week’s episode, we’ll be discussing valvular disorders, in essence, heart murmurs.
There are LOADS of Picmonics available for heart murmurs. A couple of my favorites Mitral Regurgitation and Aortic Stenosis.
Systole=ventricles contracting
Diastole=ventricles relaxing & refilling
S1=beginning of systole. AV valves (mitral & tricuspid) are closing. “lub”
S2=end of systole. Semilunar valves closing (aortic & pulmonic) “dub”
Lub, dub, rest, lub, dub, rest
 
Murmur Accentuation Maneuvers
The following applies to all murmurs except that of hypertrophic cardiomyopathy, in which the opposite is true

* Position:

* Aortic=increased with leaning forward
* Mitral=LLD

* Increased venous return

* Squatting
* Leg raise
* Lying down
* Later click in MVP

* Inspiration

* Right sided murmurs only

* Also due to increased venous return

* Expiration

* Left sided murmurs only

* Also due to increased venous return

* Increased Afterload

* Handgrip
* Increases regurgitation murmurs

* Pushes backward

Aortic Stenosis

* #1 valvular disease
* Etiologies:

* Calcification
* Bicuspid valve (if under 70y.o.)

* Systolic, crescendo-descrescendo ejection murmur

* At right upper sternal border (the location of the aortic valve)
* With radiation to the carotids

* Narrowed pulse pressure
* Pulsus parvus et tardus

* Small, delayed, carotid pulse
* Not specific to aortic stenosis

* Can lead to angina, syncope, LVH, and CHF
* Tx:

* VALVE REPLACEMENT

* Once symptomatic
* Mechanical valves (vs bioprosthetic) require lifelong anticoagulation

Mitral Stenosis

* Etio: rheumatic heart disease
* Early mid-diastolic rumble preceded by an opening snap

* At apex (location of mitral valve)
* Increased in left lateral decubitus position
* Prominent S1 (stenotic mitral valve closes forcefully)

* Symptoms

* Pulmonary symptoms

* Blood backs into lungs
* Pulmonary htn

* Atrial fibrillation

* 2/2 atrial enlargement

* “mitral facies”

* Flushed cheeks with facial pallor

* Treatment:

* Percutaneous balloon valvuloplasty

* Younger patients
* Non-calcified valves

* Valve replacement otherwise

Mitral Regurgitation

* Etio:

* mitral valve prolapse #1
* papillary muscle dysfunction

* ischemia/infarction

* Blowing, holosystolic murmur

* At Apex (location of mitral valve)
* Radiation to axilla
* Blowing=regurg
* Widely split S2

* Aortic valve closes early due to decreased LV ejection time
* Pulmonic valve closes late due to pulmonary htn (increased pressure to overcome)