5.12.16

PACES station 3

Cardiovascular System: Murmurs

PACES station 3 CVS (systolic murmur)

1-Systolic murmur in the aortic area
(a) Aortic stenosis: low volume pulse/difficult to feel, radiation to carotid (check both side)
(b) Aortic sclerosis: normal pulse volume, no carotid radiation (say mild AS and flow murmur as your differentials)
(c) HOCM: associated MR may be present (dynamic auscultation)
(d) Flow murmur: associated aortic valve replacement (AVR)

2-Systolic murmur in pulmonary area
(a) ASD: thrill, pulmonary hypertension, fixed splitting of S2, atrial fibrillation
(b) Pulmonary stenosis (PS): thrill, rare
(c) Pulmonary flow murmur: associated cyanosis, clubbing & polycythemia in Tetralogy of Fallot (TOF)
(d) HOCM: associated MR may be present (dynamic auscultation)

3-Systolic murmur in tricuspid/lower left sternal area
(a) VSD: younger age, pulmonary hypertension
(b) Tricuspid regurgitation: secondary to MS/pulmonary HTN, Ebstein anomaly (cyanosis, clubbing), pulsatile liver or epigastrium
(c) Mitral regurgitation: axilla radiation, apical thrill, more prominent in apex, atrial fibrillation

4-Systolic murmur in apical area
(a) MR including mitral valve prolapse (MVP) and HOCM
(b) TR
(c) VSD
(d) AS (radiation, also present in aortic area with carotid radiation)

No comments:

Post a Comment

Related Posts Plugin for WordPress, Blogger...