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)
