Murmurs

Murmurs

Paradoxical emboli –> ASD –> Wide, fixed splitting S2 (fixed=nochange in respiration)

• Pulmonic area –> mid-systolic ejection murmur –> resulting from increased blood flow across pulmonic valve
• Mid-diastolic rumble –> increased flow across tricuspid valve

Ejection Systolic Murmer —> HOCM / AS –> Increases in intensity on Standing? –> HOCM; Decreases in intensitity on Standing? –> AS

Valsalva Maneuver –> Decrease Venous return

• Bearing down, forceful exhalation

Valsalva –> Loud Murmer in ?

• Loud in HOCM
• Decreasing LVFilling –> Increase LV Outflow tract Obstruction (worsens) –> Murmer loud!

Valsalva –> Softer Murmur in ?

• Soft in AS
• Decrease LV Filling –> Decrease LVEDP –> less gradient, softer murmer

HOCM Murmur

• Anything that reduces Preload –> Increase Murmur intensity
• Anything that increases Afterload –> Decrease Murmur intensity

POST MI, continued High CK

• Reperfusion injury –> O2 radical damage to cell wall by neutrophils –> CK release from BRAIN/HEART/Muscle

Bone morphogenetic protein receptor type II or BMPR2 is a serine/threonine receptor kinase

• BMPR2
• Connective tissue disease, HIV infection

AR, MR, VSD murmurs increase when __load increases?

• Afterload increases
• handgrip, squatting

LOUD P2 component

• Pulmonary Arterial Hypertension –> forceful closure of the value (LOUD P2) –> progressive RV Concentric HYpetrophy –> Left parasternal heave

Delayed P2 and Soft P2 Component

• Pulmonary Valve Stenosis

Holosystolic

• MR, AR, VSD

Location MR –>