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Discussion Starter · #1 ·
I am facing too much problem in understanding the murmurs, is there any way to differentiate them, when I listen to them, not able to tell the findings. Is there any way to master them ?? :confused::toosad:
 

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u will not have time to listen to media in real exam
the way that i used it in step 2ck exam
for every murmur will come in exam will give u a creteria to know that murmur
for eg in AS will tell radiate to carotid
for ms will say mid diastolic in apex
for mvp will say there is click after murmur
and stuff that increase or decrease the murmur like hand grip and standing
thats the way we use it to know the answer
so dont bother ur self by listening
 

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Discussion Starter · #5 ·
u will not have time to listen to media in real exam
the way that i used it in step 2ck exam
for every murmur will come in exam will give u a creteria to know that murmur
for eg in AS will tell radiate to carotid
for ms will say mid diastolic in apex
for mvp will say there is click after murmur
and stuff that increase or decrease the murmur like hand grip and standing
thats the way we use it to know the answer
so dont bother ur self by listening
If question is asked in this way,then I would not be worry about murmurs :indifferent:
 

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Try this

I've been there...but don't loose patience.
I've attached a very nice material that help to get through...print it and go slowly trough it and listen to the different heart sounds during the explication. Is redundant, but if you don't start hearing normal sonuds u wont get the abnormal...(helps me if I follow the sounds with my fingers). You will get it with practice...as long as u start to hear them the ones only in systole and the ones only in Dyastole...you will feel comfortable...
Go through the guide slowly with put being anxious...it explains why every sound...why the radiation.

You most know the locations of the murmurs

  • Upper Right Sternal Border = Aortic.
  • Upper Left Sternal Border = Pulmonic.
  • Lower Left Sternal Border = Tricupid.
  • Left 5th intercostal space at midclavicular line = Mitral.
So if they say the point the murmur is heard loudest is at the midclavicular line, you KNOW its a mitral murmur!! :))

Determine if its a systolic or diastolic murmur

MRS MSD hARD ASS
MR mitral regurgitation Systolic
MS mitral stenosis Dyastolic
AR aortic regurgitation Dyastolic
AS aortic stenosis Systole

If the murmur is at the upper right sternal border, it MUST be an aortic murmur.

Is it systolic? Stenosis. Diastolic? Regurg. :))

RiLe

Right Side murmurs increased with Inspiration
Tricuspid
Pulmonary
Right-sided heart sounds increase on inspiration because during inspiration the blood is increased to the heart (less intrathoracic pressure), thus there is more blood flow through the right side of the heart--> louder heart sounds

Left Side murmurs increased with Expiration
Mitral
Aortic
Left-sided heart sounds increase on expiration because during expiration, you are pushing your blood out into the systemic circulation (more intrathoracic pressure), thus there is more blood flow through the left side of the heart--> louder heart sounds

There are a couple places they can trick you.
Mitral Regurg/Prolapse.
You need to be able to pick up a click if there is one. Is there a click? Prolapse.
If there's a click and its a diastolic murmur, it CAN'T be prolapse, it has to be Stenosis

They're also big on classic associations.:D
If its a mitral prolapse, its almost always in a Marfan's or adult polycystic kidney disease patient.
PDAs and ASDs are almost always in newborns.
Aortic stenosis is almost always in a 60 year old man.
If its a tricuspid murmur, its almost always in an IVDU.
Mitral murmurs almost always with rheumatic fever.

But as I say once you understand Heart Murmurs practice hearing them

You can go through the heart sounds in this link...
http://depts.washington.edu/physdx/heart/demo.html

Hope it helps...!:cool::cool:
 

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Discussion Starter · #8 ·
what is the effect of valsava manoeuvre and hand gripping on the intensity of murmur due to Mitral valve prolapse . . ?with explanation . .
Mitral valve prolapse

Any maneuver that decreases left ventricular volume - such as standing, sitting, Valsalva maneuver, and amyl nitrate inhalation - can produce earlier onset of clicks, longer murmur duration, and decreased murmur intensity. Any maneuver that increases left ventricular volume - such as squatting, elevation of legs, hand grip, and phenylephrine - can delay the onset of clicks, shorten murmur duration, and increase murmur intensity.
 

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Discussion Starter · #9 ·
Handgrip maneuver

Since increasing afterload will prevent blood from flowing in a normal forward path, it will increase any murmurs that are due to backwards flowing blood.This includes Aortic Regurgitation (AR), Mitral Regurgitation (MR) and Ventricular Septal Defects (VSD) (murmur increases in intensity).

Murmurs that are due to forward flowing blood such as Aortic Stenosis, Mitral Stenosis, Hypertrophic Cardiomyopathy and Mitral valve prolapse are improved (murmur decreases in intensity)
 

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Mitral valve prolapse

Any maneuver that decreases left ventricular volume - such as standing, sitting, Valsalva maneuver, and amyl nitrate inhalation - can produce earlier onset of clicks, longer murmur duration, and decreased murmur intensity. Any maneuver that increases left ventricular volume - such as squatting, elevation of legs, hand grip, and phenylephrine - can delay the onset of clicks, shorten murmur duration, and increase murmur intensity.
Correct me if I'm wrong but I think for MVP the murmur intensity decreases with increased preload (hence increases with decreased preload).
 

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Discussion Starter · #11 ·
Can any one please explain it,I am confused too.

mitral valve prolapse:

Any maneuver that decreases left ventricular volume - such as standing, sitting, Valsalva maneuver, and amyl nitrate inhalation - can produce earlier onset of clicks, longer murmur duration, and decreased murmur intensity. Any maneuver that increases left ventricular volume - such as squatting, elevation of legs, hand grip, and phenylephrine - can delay the onset of clicks, shorten murmur duration, and increase murmur intensity.
Source: http://en.wikipedia.org/wiki/Systolic_heart_murmur

The murmur of mitral valve prolapse is accentuated by standing and valsalva maneuver (earlier systolic click and longer murmur) and diminished with squatting (later systolic click and shorter murmur). The only other heart murmur that follows this pattern is the murmur of hypertrophic cardiomyopathy.
Source:http://en.wikipedia.org/wiki/Mitral_valve_prolapse
 

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The click and murmur occur earlier with standing, during the strain phase of the Valsalva maneuver, and with any intervention that decreases LV volume, exaggerating the propensity of mitral leaflet prolapse.

Conversely, squatting and isometric exercises, which increase LV volume, diminish MVP; the click-murmur complex is delayed, moves away from S1, and may even disappear.

(Taken from Harrison's chapter on valvular heart disease)

These auscultation findings are why we can symptomatically relieve MVP using beta blockers (decrease heart rate allowing the LV to fill more over a longer period of time hence decreasing the murmur intensity).
 

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What Goljan Audio says

Just a minor observation:

In the second cardiovascular lecture, Goljan says that pulmonic stenosis "increases on expiration".

It should of course be that it increases on inspiration, cause it's a right sided murmur. Right?

Has anyone else noticed this?
 

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mvp=mr

Handgrip maneuver

Since increasing afterload will prevent blood from flowing in a normal forward path, it will increase any murmurs that are due to backwards flowing blood.This includes Aortic Regurgitation (AR), Mitral Regurgitation (MR) and Ventricular Septal Defects (VSD) (murmur increases in intensity).

:confused:isnt mvp increased in intensity on hand grip
 
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