JVP Pulse Neck Apex beat Parasternal Thrill Sound

Mitral Regurgitation Mitral area/apex Normal JVP Normal or sharp upstroke Displaced, diffuse & hyperdynamic Left atrial enlargement Apical thrill Blowing, high-pitched Soft or absent S1

Pansystolic murmur (PSM) Tricuspid Regurgitation Left sternal edge Increased JVP if RVF ('v' wave)

RV heave Thrill at LSE

Radiation Shaped Manuevers Liver Severe

Radiates to axilla Plateau-shaped Decreases with inspiration

Radiates to xiphoid Increases with inspiration Pulsatile liver; right nipple dance

Small vollume pulse LV enlargement Loud S3 Soft S1 Early A2 Early diastolic rumble Signs of PH Signs of LVF MVP/Marfan's Ruptured chordae - spontaneous *RHD *IE Papillary dysfunction - IHD, CTD Functional (LV dilation) Cardiomyopathy

Causes

RHD - rare, usually with mitral IE Functional - RVF Ebstein anomaly Prolapse Trauma

S3- low pitched mid-diastolic sound, caused by tautening of papillary muscles at the end of rapid diastolic filling, Pathological S3 S4- higher-pitched late-diastolic sound. High pressure atrial wave reflected back from poorly compliant ventricle. Does not occu

murmur (PSM) VSD Normal or increased ('a' wave in PH) Plateau or anacrotic; parvus et tardus Hyperkinetic, displaced Thrill at LSE Harsh S3/S4 Radiates to right sternal edge Plateau-shaped Unchanged*/louder on expiration Hyperdyamic & slightly displaced Systolic thrill at base of heart Harsh, extending into carotids Narrowly split or reversed S2; ejection click Over praecordium and apex Sitting up in full expiration Aortic stenosis Right sternal edge

Ejection Systolic murmur

Congenital Acquired - MI - ruptured septum

muscles at the end of rapid diastolic filling, Pathological S3 is due to reduced ventricular compliance. Associated with increased atrial pressure ected back from poorly compliant ventricle. Does not occur in AF.

Ejection Systolic murmur Pulmonary stenosis Left sternal edge Increased JVP (Giant 'a' wave)

ASD

RV heave Pulmonary thrill

Normal or RV enlargement OR low-pitched diastolic murmur

RV S4; ejection click

Fixed S2 splitting

Inspiration Pre-systolic pulsation

Inspiration

ular compliance. Associated with increased atrial pressure

Early diastolic murmur Aortic regurgitation Pulmonary regurgitation Left sternal edge Left sternal edge Collapsing pulse/bisferiens (with AS) Prominent carotid pulsations (Corrigan's sign) Displaced & hyperkinetic Diastolic thrill at LSE Loud decrescendo Austin Flint (mid-diastolic & presystolic) Soft A2, LV S3

Decrescendo, high-pitched Graham Steell Loud S2? dt PH

Sitting up in expiration

typically increase in inspiration

Mid diastolic murmur Mitral stenosis Tricuspid stenosis Apex Left sternal edge Normal; 'a' wave if PH, none if AF Giant 'a' waves with slow y descent Normal or reduced Tapping; palpable S1, palpable P2 Left atrial enlargement; RV heave Late diastolic accentuation Loud S1; loud P2, opening snap SAME AS MS except for site clicks for mobile semilunar valves snap for mitral

Left lateral position

Inspiration Pre-systolic pulsation