Inspiration increases which murmur

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Mitral stenosis Low-pitched, rumbling murmur heard throughout diastole: a whispered letter "r". Pulmonary regurgitation Increases with inspiration Aortic insufficiency Sometimes best heard if the patient is made to site up, lean forward and breathe out fully while the stethoscope at the left side of the lower part of the sternum.

Mitral stenosis Best heard as the patient is rolled onto left side with stethoscope bell at apex. Neck Veins. In HOCM, the murmur gets quieter with increased afterload In mitral valve prolapse, the murmur gets louder.

Distinguishing diastolic murmurs These could be damn near anything. Really, there are 4 left-sided murmurs one should be familiar with, and two right-sided murmurs. Louder on expiration Aortic regurgitation Mitral stenosis Austin Flint murmur of aortic regurgitation Carey Coombs murmur of acute rheumatic fever Louder on inspiration Pulmonary regurgitation Tricuspid stenosis Distingusihing between the left-sided diastolic murmurs: Mitral stenosis is best heard with the bell, and is low pitched With mitral stenois, there is usually an opening snap shortly after S2 With mitral stenosis, there is usually a loud S1 Aortic regurgitation is best heard with the diaphragm, and is high-pitched.

There is no opening snap and the S1 is soft with aortic regurgitation Distinguishing between pulmonary regurgitation and tricuspid stenosis Tricuspid stenosis is freakishly rare; typicaly its a diastolic murmur heard best at the left sternal edge. Unlike pulmonic regurgitation, tricuspid stenosis causes a presystolic pulsation of the liver, which is caused by the forceful contraction of the atrium against a stenotic valve.

Pulmonic regurgitation is also freakishly rare; they call it the Graham Steell murmur. It is typically the result of pulmonary artery dilatation in the context of pulmonary hypertension. If there is no sign of pulmonary hypertension, you may be listening to an aortic regurgitation instead. Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where. Question Congenital Carcinoid syndrome. Congenital Myocardial infarction. Left sternal edge Presystolic pulsation of the liver.

Pulmonary hypertension Infective endocarditis Congenital absence of the pulmonary valve. Louder with Valsalva. Papillary muscle failure due to ischaemia Myxomatous degeneration Marfans syndome. Quieter with Valsalva. Radiates to carotids Ejection systolic Plateau pulse Quieter with isometric hand grip. Degenerative calcification Congenital bicuspid valve Rheumatic heart disease. Mitral valve prolapse Age-associated Rheumatic heart disease Infective endocarditis Papillary muscle failure due to ischaemia Dilated cardiomyopathy Marfan's syndrome Rheumatoid arthritis, Ankylosing spondylitis;.

Quiet S1 No opening snap Collapsing pulse. Rheumatic heart disease bicuspid valve seronegative arthropathy, eg. Rheumatic heart disease Congenital parachute valve.