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Name all the diastolic murmurs
- Pulmonic regurgitation
- Mitral stenosis
- Tricuspid stenosis
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Name the Continuous murmurs
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Name the systolic murmurs
- Aortic stenosis
- Bicuspid aortic valve
- Pulmonic stenosis
- HOCM
- Mitral regurgitation
- MVP with mitral regurgitation
- Papillary muscle dysfunction or rupture
- Atrial septal defect
- VSD
- Tricuspid regurgitation
- Innocent flow murmur
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Define pulsus parvus
A pulse of small amplitude
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Define Pulsus parvus et tardus
a small pulse with low pressure that rises and falls gradually. The condition occurs in aortic stenosis.
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Define Pulsus paradoxus
an abnormal inspiratory decrease in arterial blood pressure,
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Crescendo-decrescendo, midsystolic murmur located at the base and radiates to the carotids, characterized by single S2, pulsus parvus, S4, palpable apical
impulse
Aortic stenosis
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Crescendo-decrescendo, midsystolic murmur located at the base, no radiation
Pulmonic Stenosis
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Crescendo, mid- or late systolic murmur located at the base, radiates to the carotids. Bifid carotid pulse. Murmur decreases with passive leg elevation or hand grip, increased with valsalva
HOCM
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Holo- or late systolic murmur. located at the apex, and radiates to the axilla or back
Mitral regurgitation
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Late systolic murmur located at the apex, radiates to the axilla. With Valsalva, murmur decreases and midsystolic cllick moves closer to S1
Mitral valve prolapse with mitral regurgitation
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Crescendo-decrescendo, midsystolic murmur located at the Base, and radiating to the Carotids
Bicuspid aortic valve
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Holosystolic murmur at the LLSB, no radiation. Palpable thrill; murmur increases with isometric exercise, decreases with amyl nitrate
Ventricular septal defect
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Holosystolic murmur located at the LLSB, radiates to the LRSB. Prominent v waves in neck, hepatic pulsation; murmur increases with inspiration; in severe TR, abdominal ascites, pedal edema; with pulmonary hypertension, loud pulmonic component of S2
Tricuspid regurgitation
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Decrescendo diastolic murmur at LLSB, no radiation. Enlarged apical impulse, widened pulse pressure, bounding carotid pulses; murmur best heard in upright position, leaning forward, end-expiration
Aortic regurgitation
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Mid-diastolic murmur at the LLSB, no radiation. Loud S2 if pulmonary hypertension is present
Pulmonic regurgitation
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Low-pitched diastolic rumble at the apex, no radiation. Murmur best heard in left lateral decubitus position; opening snap; palpable P2; irregular pulse if atrial fibrillation is present
Mitral stenosis
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Low-pitched diastolic rumble at the LLSB, radiates to the RUQ, characterized by a right ventricular heave
Tricuspid stenosis
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Machinery-like continuous at the base, radiates to the back. May have widened pulse pressure
Patent ductus arteriosus
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Soft, humming continuous murmur, located between breast and sternum, no radiation.
Mammary souffle
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Accentuation midsystole, but continuous, located over back, radiates to the back. Characterized by higher blood pressure in arms versus legs
Coarctation of the aorta
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Right ventricular impulse, fixed splitting of the S2, a pulmonary mid-systolic murmur and a trucuspid diastolic flow rumble
ASD
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Describe the physical findings in ASD.
Right ventricular impulse, fixed splitting of the S2, a pulmonary mid-systolic murmur and a trucuspid diastolic flow rumble
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Describe physical exam findings in HOCM
- dynamic systolic murmur that increases with Valsalva maneuver release.
- The apical impulse is often displaced and bifid.
- A parasternal impulse would not be expected, and the S2 should be normal.
- The electrocardiogram in patients with hypertrophic cardiomyopathy demonstrates left ventricular hypertrophy.
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Physical exam findings in a pt with pulmonary arterial HTN
- parasternal impulse and a loud pulmonic component of the S2, which changes with respiration.
- The electrocardiogram in patients with pulmonary arterial hypertension demonstrates features of right axis deviation, right ventricular hypertrophy with tall R waves in the right precordial leads (V1 and V2) and deep S waves in the left precordial leads (V5 and V6), and, occasionally, a right ventricular strain pattern.
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Describe the physical exam findings in pts with rheumatic heart disease
- loud S1, variable S2, and an opening snap, followed by a low-pitched diastolic murmur.
- In the setting of concomitant pulmonary hypertension: the S2 is loud and splits during inspiration but does not remain split during expiration.
- The electrocardiogram in patients with mitral stenosis demonstrates features of left atrial enlargement and hypertrophy.
- When pulmonary hypertension occurs, right ventricular hypertrophy is also demonstrated.
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Characteristic features of what valve defect include a prominent a wave in the jugular venous pulse contour, a parasternal impulse, an ejection click, a systolic thrill, and an early systolic murmur that increases with inspiration.
Pulmonary valve stenosis
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What are the characteristic features of pulmonary valve stenosis?
Characteristic features of pulmonary valve stenosis include a prominent a wave in the jugular venous pulse contour, a parasternal impulse, an ejection click, a systolic thrill, and an early systolic murmur that increases with inspiration.
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