tabuk university

1. Murmurs
S1 S2 S1 S2
nspirationivalve lesions will increased withRt side_ all
( T & P valves )
expirationvalve lesions will increased withLt side_ all
( M & A valves )
_ crescendo –decrescendo murmur :
1- A.S 2- HOCM
_decrescendo murmur = A.R
_blowing murmur :
1-M.R 2- A.R
thrill_ Grade 4 murmur associated with
patient rolled toleft side_ M.S murmur will be very clear when
patient leaning forward at end of_ A.R murmur will be very clear when
expiration
Systole diastole
At systole: normally
1-mitral + tricuspid
valves will close
2-polmonary + aortic
valves will open
so, ifthere is:
openingin M.Vor T.V ( Regurgitation)
or
narrowing in A.V or P.V ( stenosis)
that will leadto systolic murmur
L.V contracts
to eject the
blood to aorta
At diastole : normally
1-mitral + tricuspid
valves will open
2-polmonary + aortic
valves will close
so, ifthere is:
narrowing in M.V or T.V (stenosis)
or
openingin A.Vor P.V (Regurgitation)
that will leadto diastolic murmur
Blood fills
the L.V + R.V

2. Pan Systolic = holosystolic
ejection systolic
Ejection Systolic Murmur
Close toICSth
Lt 5At tricuspid area(
sternum)
1-radiates to Rt No
Sternal border
2-increase with No
Inspiration
Dx : T.R Dx : VSD
At Apex
Radiate to axilla
Dx : M.R
(blowing Murmur )
At Apex
Dx : M.R
At aortic area
ICS )nd
(Rt 2
Radiate to coronary
arteries
Dx : A.S
(crescendo–decrescendo)
At Pulmonary area
ICS )nd
(Lt 2
Dx : P.S
Flow murmur with ASD
Lt Sternal border
HOCM
(crescendo–decrescendo)
Systolic Murmur

3. Diastolic murmur
At Apex
Dx : M.S
_opening snap
_delay rumbling murmur
At Left Sternal border
1-Dx : A.R
_Blowing murmur
_decrescendo murmur
_early diastolic murmur
2-Dx : P.R
At tricuspid area
1-Dx : T.S
PDA:Dx=machine like murmur_ continuous
_ Late systolic crescendo murmur with mid systolic click = MVP
_ splitting :
Wide : 1-P.S 2- Rt BBB ( Bundle branch block )
Fixed : ASD
Paradoxical : 1-A.S 2- Lt BBB
_ S3 ( heard in early diastole ) :
Normal in children and pregnancy
cardiomyopathyatedin adult : CHF _ dilAbnormal
_S4 ( heard in late diastole ) :
1-M.I
2- LVH 2ry HTN - A.S
3- HOCM