7/17/2019 Medicine OSCE Notes Murmurs

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Timing Timing Position where murmur is best heard Lesion Maneuvours to accentuate murmur

 Aortic area, clavicles & carotids, also apex Aortic Stenosis Squatting. Leg raise. Sitting in full Exp

Pulmonary Stenosis

Mid systolic (Ejection) Atrial Septal Defect

Lower LSE (4-5th IC spaces) & apex Hypertrophic Cardiomyopathy Accentuated on Standing. Valsalva

 Atrial Septal Defect

 Aortic or Pulmonary areas Anaemia, Thyrotoxicosis, Pregnancy

Systolic Lower LSE & apex Hypertrophic Cardiomyopathy Accentuated on Standing. Valsalva

Late Systolic Apex Mitrial Valve Prolapse Earlier & louder with Valsalva

Left Sternal edge Coarctation of the Aorta

Pansystolic Apex to Axilla Mitrial Regurg (blowing, high freq) Squatting, leg raise, hand grip

Left Sternal edge Tricuspid Regurg (low pitched)

Ventricular Septal Defect

Early Diastolic LSE (3-4th IC spaces) & Apex Aortic Regurg (blowing, high pitched) Sitting forward in full expiration

Right (or Left) Sternal edge Pulmonary Regurg Inspiration

Murmur 

 Apex Mitral Stenosis (low freq, rumbling) Left lateral position

Diastolic Mid Diastolic Austin Flint (aortic regurg)

Left Sternal edge Tricuspid Stenosis

Late Diastolic Apex Mitral Stenosis Left lateral position

(Presystolic) Left Sternal edge Tricuspid Stenosis

 Atrial Myxoma

Left 1st or 2nd IC space Midclav line Patent Ductus Arteriosis

 A V Fistula

Continuous Entire Cardiac Cycle Aorto-pulmonary Fistula

Venous Hum in Children Decreased by occluding vein or by

Bell (Low pitched) Diaphragm (High pitched lying child flat

Mitral stenosis Aortic regurg

 Austin Flint Mitral valve prolapse

Tricuspid stenosis Pulmonary regurg Remember R.I.L.E

InspirationLeft Sternal Edge (3-4th IC spaces)

Murmurs: right vs. left loudness "RILE":

Right sided heart murmurs are louder on Inspiration.Left sided heart murmurs are loudest on Expiration.