PT Inquest is an online journal club. Hosted by Jason Tuori, Megan Graham, and Chris Juneau, the show looks at an article every week and discusses how it applies to current physical therapy practice.
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Heart Murmurs Part 1
MP3•Episode home
Manage episode 204908315 series 2108787
Content provided by PA Study Sesh. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by PA Study Sesh or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
During this week’s episode, we’ll be discussing valvular disorders, in essence, heart murmurs.
There are LOADS of Picmonics available for heart murmurs. A couple of my favorites Mitral Regurgitation and Aortic Stenosis.
Systole=ventricles contracting
Diastole=ventricles relaxing & refilling
S1=beginning of systole. AV valves (mitral & tricuspid) are closing. “lub”
S2=end of systole. Semilunar valves closing (aortic & pulmonic) “dub”
Lub, dub, rest, lub, dub, rest
Murmur Accentuation Maneuvers
The following applies to all murmurs except that of hypertrophic cardiomyopathy, in which the opposite is true
* Position:
* Aortic=increased with leaning forward
* Mitral=LLD
* Increased venous return
* Squatting
* Leg raise
* Lying down
* Later click in MVP
* Inspiration
* Right sided murmurs only
* Also due to increased venous return
* Expiration
* Left sided murmurs only
* Also due to increased venous return
* Increased Afterload
* Handgrip
* Increases regurgitation murmurs
* Pushes backward
Aortic Stenosis
* #1 valvular disease
* Etiologies:
* Calcification
* Bicuspid valve (if under 70y.o.)
* Systolic, crescendo-descrescendo ejection murmur
* At right upper sternal border (the location of the aortic valve)
* With radiation to the carotids
* Narrowed pulse pressure
* Pulsus parvus et tardus
* Small, delayed, carotid pulse
* Not specific to aortic stenosis
* Can lead to angina, syncope, LVH, and CHF
* Tx:
* VALVE REPLACEMENT
* Once symptomatic
* Mechanical valves (vs bioprosthetic) require lifelong anticoagulation
Mitral Stenosis
* Etio: rheumatic heart disease
* Early mid-diastolic rumble preceded by an opening snap
* At apex (location of mitral valve)
* Increased in left lateral decubitus position
* Prominent S1 (stenotic mitral valve closes forcefully)
* Symptoms
* Pulmonary symptoms
* Blood backs into lungs
* Pulmonary htn
* Atrial fibrillation
* 2/2 atrial enlargement
* “mitral facies”
* Flushed cheeks with facial pallor
* Treatment:
* Percutaneous balloon valvuloplasty
* Younger patients
* Non-calcified valves
* Valve replacement otherwise
Mitral Regurgitation
* Etio:
* mitral valve prolapse #1
* papillary muscle dysfunction
* ischemia/infarction
* Blowing, holosystolic murmur
* At Apex (location of mitral valve)
* Radiation to axilla
* Blowing=regurg
* Widely split S2
* Aortic valve closes early due to decreased LV ejection time
* Pulmonic valve closes late due to pulmonary htn (increased pressure to overcome)
…
continue reading
There are LOADS of Picmonics available for heart murmurs. A couple of my favorites Mitral Regurgitation and Aortic Stenosis.
Systole=ventricles contracting
Diastole=ventricles relaxing & refilling
S1=beginning of systole. AV valves (mitral & tricuspid) are closing. “lub”
S2=end of systole. Semilunar valves closing (aortic & pulmonic) “dub”
Lub, dub, rest, lub, dub, rest
Murmur Accentuation Maneuvers
The following applies to all murmurs except that of hypertrophic cardiomyopathy, in which the opposite is true
* Position:
* Aortic=increased with leaning forward
* Mitral=LLD
* Increased venous return
* Squatting
* Leg raise
* Lying down
* Later click in MVP
* Inspiration
* Right sided murmurs only
* Also due to increased venous return
* Expiration
* Left sided murmurs only
* Also due to increased venous return
* Increased Afterload
* Handgrip
* Increases regurgitation murmurs
* Pushes backward
Aortic Stenosis
* #1 valvular disease
* Etiologies:
* Calcification
* Bicuspid valve (if under 70y.o.)
* Systolic, crescendo-descrescendo ejection murmur
* At right upper sternal border (the location of the aortic valve)
* With radiation to the carotids
* Narrowed pulse pressure
* Pulsus parvus et tardus
* Small, delayed, carotid pulse
* Not specific to aortic stenosis
* Can lead to angina, syncope, LVH, and CHF
* Tx:
* VALVE REPLACEMENT
* Once symptomatic
* Mechanical valves (vs bioprosthetic) require lifelong anticoagulation
Mitral Stenosis
* Etio: rheumatic heart disease
* Early mid-diastolic rumble preceded by an opening snap
* At apex (location of mitral valve)
* Increased in left lateral decubitus position
* Prominent S1 (stenotic mitral valve closes forcefully)
* Symptoms
* Pulmonary symptoms
* Blood backs into lungs
* Pulmonary htn
* Atrial fibrillation
* 2/2 atrial enlargement
* “mitral facies”
* Flushed cheeks with facial pallor
* Treatment:
* Percutaneous balloon valvuloplasty
* Younger patients
* Non-calcified valves
* Valve replacement otherwise
Mitral Regurgitation
* Etio:
* mitral valve prolapse #1
* papillary muscle dysfunction
* ischemia/infarction
* Blowing, holosystolic murmur
* At Apex (location of mitral valve)
* Radiation to axilla
* Blowing=regurg
* Widely split S2
* Aortic valve closes early due to decreased LV ejection time
* Pulmonic valve closes late due to pulmonary htn (increased pressure to overcome)
22 episodes
MP3•Episode home
Manage episode 204908315 series 2108787
Content provided by PA Study Sesh. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by PA Study Sesh or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://player.fm/legal.
During this week’s episode, we’ll be discussing valvular disorders, in essence, heart murmurs.
There are LOADS of Picmonics available for heart murmurs. A couple of my favorites Mitral Regurgitation and Aortic Stenosis.
Systole=ventricles contracting
Diastole=ventricles relaxing & refilling
S1=beginning of systole. AV valves (mitral & tricuspid) are closing. “lub”
S2=end of systole. Semilunar valves closing (aortic & pulmonic) “dub”
Lub, dub, rest, lub, dub, rest
Murmur Accentuation Maneuvers
The following applies to all murmurs except that of hypertrophic cardiomyopathy, in which the opposite is true
* Position:
* Aortic=increased with leaning forward
* Mitral=LLD
* Increased venous return
* Squatting
* Leg raise
* Lying down
* Later click in MVP
* Inspiration
* Right sided murmurs only
* Also due to increased venous return
* Expiration
* Left sided murmurs only
* Also due to increased venous return
* Increased Afterload
* Handgrip
* Increases regurgitation murmurs
* Pushes backward
Aortic Stenosis
* #1 valvular disease
* Etiologies:
* Calcification
* Bicuspid valve (if under 70y.o.)
* Systolic, crescendo-descrescendo ejection murmur
* At right upper sternal border (the location of the aortic valve)
* With radiation to the carotids
* Narrowed pulse pressure
* Pulsus parvus et tardus
* Small, delayed, carotid pulse
* Not specific to aortic stenosis
* Can lead to angina, syncope, LVH, and CHF
* Tx:
* VALVE REPLACEMENT
* Once symptomatic
* Mechanical valves (vs bioprosthetic) require lifelong anticoagulation
Mitral Stenosis
* Etio: rheumatic heart disease
* Early mid-diastolic rumble preceded by an opening snap
* At apex (location of mitral valve)
* Increased in left lateral decubitus position
* Prominent S1 (stenotic mitral valve closes forcefully)
* Symptoms
* Pulmonary symptoms
* Blood backs into lungs
* Pulmonary htn
* Atrial fibrillation
* 2/2 atrial enlargement
* “mitral facies”
* Flushed cheeks with facial pallor
* Treatment:
* Percutaneous balloon valvuloplasty
* Younger patients
* Non-calcified valves
* Valve replacement otherwise
Mitral Regurgitation
* Etio:
* mitral valve prolapse #1
* papillary muscle dysfunction
* ischemia/infarction
* Blowing, holosystolic murmur
* At Apex (location of mitral valve)
* Radiation to axilla
* Blowing=regurg
* Widely split S2
* Aortic valve closes early due to decreased LV ejection time
* Pulmonic valve closes late due to pulmonary htn (increased pressure to overcome)
…
continue reading
There are LOADS of Picmonics available for heart murmurs. A couple of my favorites Mitral Regurgitation and Aortic Stenosis.
Systole=ventricles contracting
Diastole=ventricles relaxing & refilling
S1=beginning of systole. AV valves (mitral & tricuspid) are closing. “lub”
S2=end of systole. Semilunar valves closing (aortic & pulmonic) “dub”
Lub, dub, rest, lub, dub, rest
Murmur Accentuation Maneuvers
The following applies to all murmurs except that of hypertrophic cardiomyopathy, in which the opposite is true
* Position:
* Aortic=increased with leaning forward
* Mitral=LLD
* Increased venous return
* Squatting
* Leg raise
* Lying down
* Later click in MVP
* Inspiration
* Right sided murmurs only
* Also due to increased venous return
* Expiration
* Left sided murmurs only
* Also due to increased venous return
* Increased Afterload
* Handgrip
* Increases regurgitation murmurs
* Pushes backward
Aortic Stenosis
* #1 valvular disease
* Etiologies:
* Calcification
* Bicuspid valve (if under 70y.o.)
* Systolic, crescendo-descrescendo ejection murmur
* At right upper sternal border (the location of the aortic valve)
* With radiation to the carotids
* Narrowed pulse pressure
* Pulsus parvus et tardus
* Small, delayed, carotid pulse
* Not specific to aortic stenosis
* Can lead to angina, syncope, LVH, and CHF
* Tx:
* VALVE REPLACEMENT
* Once symptomatic
* Mechanical valves (vs bioprosthetic) require lifelong anticoagulation
Mitral Stenosis
* Etio: rheumatic heart disease
* Early mid-diastolic rumble preceded by an opening snap
* At apex (location of mitral valve)
* Increased in left lateral decubitus position
* Prominent S1 (stenotic mitral valve closes forcefully)
* Symptoms
* Pulmonary symptoms
* Blood backs into lungs
* Pulmonary htn
* Atrial fibrillation
* 2/2 atrial enlargement
* “mitral facies”
* Flushed cheeks with facial pallor
* Treatment:
* Percutaneous balloon valvuloplasty
* Younger patients
* Non-calcified valves
* Valve replacement otherwise
Mitral Regurgitation
* Etio:
* mitral valve prolapse #1
* papillary muscle dysfunction
* ischemia/infarction
* Blowing, holosystolic murmur
* At Apex (location of mitral valve)
* Radiation to axilla
* Blowing=regurg
* Widely split S2
* Aortic valve closes early due to decreased LV ejection time
* Pulmonic valve closes late due to pulmonary htn (increased pressure to overcome)
22 episodes
All episodes
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