Murmur: Difference between revisions
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− | == |
+ | == Description == |
+ | |||
+ | === Location === |
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+ | |||
+ | * Aortic valve/right upper sternal border: second intercostal space at the right sternal border |
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+ | * Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border |
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+ | * Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border |
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+ | * Mitral valve/point of maximal impulse/apex: approximately the fifth intercostal space at the left midclavicular line |
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+ | * Radiation |
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+ | |||
+ | ===Intensity=== |
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{| class="wikitable" |
{| class="wikitable" |
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− | + | !Grade |
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− | + | !Description |
|
|- |
|- |
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|Grade 1 |
|Grade 1 |
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− | | |
+ | |Faintest sound that can be detected |
|- |
|- |
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|Grade 2 |
|Grade 2 |
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− | | |
+ | |Soft murmur that is readily detectable |
|- |
|- |
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|Grade 3 |
|Grade 3 |
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− | | |
+ | |Louder than grade 2 but not associated with a palpable thrill |
|- |
|- |
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|Grade 4 |
|Grade 4 |
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− | | |
+ | |Associated with a palpable thrill |
|- |
|- |
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|Grade 5 |
|Grade 5 |
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− | | |
+ | |Audible with stethoscope placed lightly on the chest |
|- |
|- |
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|Grade 6 |
|Grade 6 |
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− | | |
+ | |Audible with stethoscope off the chest |
|} |
|} |
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+ | === Quality === |
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+ | |||
+ | * High or low frequency |
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+ | * Blowing, harsh, musical, rumbling, squeaky |
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+ | |||
+ | === Profile === |
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+ | |||
+ | * Crescendo, decrescendo, crescendo-decrescendo, or plateau |
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+ | |||
+ | === Timing === |
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+ | |||
+ | * Systolic, diastolic |
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+ | * Early, mid, or late |
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+ | * Holosystolic |
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+ | |||
+ | == Interpretation == |
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+ | {| class="wikitable sortable mw-collapsible" |
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+ | ! rowspan="2" |Valvulopathy |
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+ | ! colspan="5" |Description |
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+ | ! colspan="5" |Maneuvers |
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+ | ! colspan="3" |Position |
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+ | |- |
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+ | !Location |
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+ | !Radiation |
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+ | !Timing |
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+ | !Quality |
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+ | !Profile |
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+ | !Inspiration |
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+ | !Isometric Handgrip (↑ Afterload) |
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+ | !Squatting (↑ Preload) |
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+ | !Valsalva (↓ Preload) |
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+ | !Release Valsalva |
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+ | !Left Lateral Decubitus |
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+ | !Learning Forward |
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+ | !Supine |
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+ | |- |
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+ | |Innocent |
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+ | |LSB |
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+ | |±apex |
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+ | |mid-systolic |
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+ | |musical, vibratory |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |↓ |
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+ | | |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | |- |
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+ | |[[Aortic regurgitation]] |
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+ | |LLSB or PMI |
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+ | |±LUSB |
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+ | |diastolic |
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+ | |blowing |
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+ | |D |
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+ | |↓ |
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+ | |↑ |
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+ | |↑ |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | |- |
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+ | |↳[[Austin Flint murmur|Austin Flint]] |
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+ | |PMI |
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+ | | |
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+ | |mid-diastolic |
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+ | |rumble |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Aortic stenosis]] |
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+ | |RUSB |
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+ | |±carotids |
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+ | |mid-systolic |
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+ | | |
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+ | |C-D |
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+ | |↓ |
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+ | | |
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+ | |↑ |
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+ | |↓ |
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+ | |↑ |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | |- |
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+ | |[[Mitral regurgitation]] |
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+ | |PMI |
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+ | |±left axilla |
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+ | |holosystolic |
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+ | | |
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+ | | |
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+ | |↓ |
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+ | |↑ |
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+ | |↑ |
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+ | |↓ |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Mitral valve prolapse]] |
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+ | |PMI |
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+ | | |
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+ | |early systolic |
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+ | |click |
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+ | | |
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+ | |↓ |
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+ | |↓ |
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+ | |↓ |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Mitral stenosis]] |
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+ | |PMI |
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+ | | |
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+ | |mid-diastolic |
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+ | |±OS, loud S1, rumble |
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+ | |D |
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+ | |↓ |
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+ | | |
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+ | |↑ |
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+ | |↓ |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Pulmonic regurgitation]] |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Pulmonic stenosis]] |
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+ | |LUSB |
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+ | | |
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+ | |systolic |
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+ | | |
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+ | |C-D |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Tricuspid regurgitation]] |
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+ | |LLSB |
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+ | | |
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+ | |systolic |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Tricuspid stenosis]] |
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+ | |LLSB |
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+ | | |
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+ | |diastolic |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | |↓ |
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+ | |↓ |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Atrial septal defect]] |
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+ | |LUSB |
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+ | | |
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+ | | |
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+ | |may be harsh; fixed split S2 |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Ventricular septal defect]] |
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+ | |PMI |
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+ | | |
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+ | |holosystolic |
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+ | |loud, high-pitched, harsh |
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+ | | |
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+ | | |
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+ | |↑ |
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+ | | |
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+ | |↓ |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Hypertrophic obstructive cardiomyopathy]] |
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+ | |PMI to LLSB |
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+ | | |
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+ | |mid-systolic |
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+ | |harsh |
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+ | |C-D |
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+ | | |
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+ | |↓ |
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+ | |↓ |
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+ | |↑ |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Patent ductus arteriosus]] |
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+ | |LUSB |
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+ | | |
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+ | |continuous |
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+ | |machine-like |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | | |
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+ | |} |
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[[Category:Clinical exam]] |
[[Category:Clinical exam]] |
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[[Category:Cardiology]] |
[[Category:Cardiology]] |
Latest revision as of 13:33, 15 March 2022
Description
Location
- Aortic valve/right upper sternal border: second intercostal space at the right sternal border
- Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border
- Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border
- Mitral valve/point of maximal impulse/apex: approximately the fifth intercostal space at the left midclavicular line
- Radiation
Intensity
Grade | Description |
---|---|
Grade 1 | Faintest sound that can be detected |
Grade 2 | Soft murmur that is readily detectable |
Grade 3 | Louder than grade 2 but not associated with a palpable thrill |
Grade 4 | Associated with a palpable thrill |
Grade 5 | Audible with stethoscope placed lightly on the chest |
Grade 6 | Audible with stethoscope off the chest |
Quality
- High or low frequency
- Blowing, harsh, musical, rumbling, squeaky
Profile
- Crescendo, decrescendo, crescendo-decrescendo, or plateau
Timing
- Systolic, diastolic
- Early, mid, or late
- Holosystolic
Interpretation
Valvulopathy | Description | Maneuvers | Position | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Location | Radiation | Timing | Quality | Profile | Inspiration | Isometric Handgrip (↑ Afterload) | Squatting (↑ Preload) | Valsalva (↓ Preload) | Release Valsalva | Left Lateral Decubitus | Learning Forward | Supine | |
Innocent | LSB | ±apex | mid-systolic | musical, vibratory | ↓ | ↑ | |||||||
Aortic regurgitation | LLSB or PMI | ±LUSB | diastolic | blowing | D | ↓ | ↑ | ↑ | ↑ | ↑ | |||
↳Austin Flint | PMI | mid-diastolic | rumble | ||||||||||
Aortic stenosis | RUSB | ±carotids | mid-systolic | C-D | ↓ | ↑ | ↓ | ↑ | ↑ | ||||
Mitral regurgitation | PMI | ±left axilla | holosystolic | ↓ | ↑ | ↑ | ↓ | ↑ | |||||
Mitral valve prolapse | PMI | early systolic | click | ↓ | ↓ | ↓ | ↑ | ||||||
Mitral stenosis | PMI | mid-diastolic | ±OS, loud S1, rumble | D | ↓ | ↑ | ↓ | ↑ | |||||
Pulmonic regurgitation | ↑ | ↑ | |||||||||||
Pulmonic stenosis | LUSB | systolic | C-D | ↑ | ↑ | ||||||||
Tricuspid regurgitation | LLSB | systolic | ↑ | ||||||||||
Tricuspid stenosis | LLSB | diastolic | ↑ | ↓ | ↓ | ||||||||
Atrial septal defect | LUSB | may be harsh; fixed split S2 | |||||||||||
Ventricular septal defect | PMI | holosystolic | loud, high-pitched, harsh | ↑ | ↓ | ||||||||
Hypertrophic obstructive cardiomyopathy | PMI to LLSB | mid-systolic | harsh | C-D | ↓ | ↓ | ↑ | ||||||
Patent ductus arteriosus | LUSB | continuous | machine-like |