Tag Archives: physical

Murmurs

JVP: Falls as you stand, disappears as you breathe in. Not a pulse, can be obliberated. Sitting lowers, lying raises.

Thrill = palpable purring murmur.
MTPA is your order of listening, and the paired valves shutting.
Systolic = Pansystolic systolic murmur of MR (in apex to axilla, louder on rolling to left side), soft s1. MR = Rheumatic, post-MI, AF.
OR slow-rising pulse of (ejection) AS (loud at neck., crescendo-decrescendo. Later peak = worse.) with a soft s2. Sit up + exhale. Heavy, displaced beat. ?HTN
AS –> CCF, cold peripheries, low BP.

Diastolic = AR/MS.
Early-diastolic fast-rising waterhammer, fast-collapsing Collapsing pulse of AR insufficiency – forwards and left sternal, after S2 decrescendo. (Lift arm up)
Mid-diastolic murmur of MS – axilla, roll onto left. Opening Snap of MS with a tapping apex and loud S1, blue flush. AF –> MR! MR AF+RF.

Regurgitations cause big left ventricles. Diffuse displaced beat in lvf/dilatation.
TR – big left pressure. Often MR + TR together. TR worse on inhalation.
S3, LVF or MR/AR, bell in mitral area. S4 before S1, not normal e.g. AS, HTN, HF. Tachy + S3/S4 = gallop

breathe out and hold your breathe for MS + AR.
LVF = pulm oedema.

MS – Malar flush, pulm HTN
AS – Slow rising pulse
AR – Collapsing waterhammer.
Radio-radial – dissection. Radio-femoral: Co-arct.