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.
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...!