S

Systole

Diastole

(S or D)
Aortic

Stenosis
2nd ICS (base)

Mitral Valve

Mitral

Aortic

Mitral Stenosis

Prolapse
(apex)

Regurgitation
(apex)

Regurgitation
R 2nd ICS (and L

(apex)

2nd, 3rd, and 4th

(locatio
n)
I
(intensit
y)
R

ICS)
Soft or loud; if

(sounds

loud, often have

blowing)

(positio

1-4

Down towards

None!

a thrill
Often to neck

L axillary region

apex

(radiati
on)
P

1-3

Pt sitting or

Can use

LLD; squatting

Pt leaning

leaning forward

Valsalva

(or legs lifted)

forward; also

LLD

when pt holds

n)

breath in

S
(shape)

Crescendo-

Mid-late systolic

Pansystolic or

exhalation
Decrescendo;

Decrescendo-

decrescendo;

click

late systolic

early

crescendo; mid

Mid-systolic
*most

*most common

LVH and LA

*use diaphragm

to late diastolic
*use bell to

commonly

valvular lesion

enlargement

*PE:

auscultate

replaced valve

*F>M

*use diaphragm

1.large bounding

*often

in heart

Serious

*S3

pulse

associated with

*valvular lesion

complications:

2. Corrigan pulse

opening snap

of sudden death

-MR

3. Pistol-shot

(OS)

*M>F

-IE

pulse

*Rheumatic

*S4

-sudden cardiac

4. Quinckes

fever!!!

*antibiotic

death

pulse

prophylaxis is

-cerebrovascular

5. Mussets pulse

no longer

ischemic events

recommended

Complications:
1. pulmonary

*LVH

HTN and HF

*LVH

*S4

2. thrombus
formation in
atrium
3. Development

Causes

1. Calcification

1. genetic

1. MVP

1. Congenitally

of A. fib
1. Rheumatic

of valve

2. anterior chest

2. Rheumatic

bicuspid aortic

fever** (nearly

associated

deformity

Heart Dz

valve

all pts with MS

w/aging

(narrow A/P

3. Connective

*2. Infective

have underlying

2. born w/2

diameter):

tissue disorders

Endocarditis

RF)

leaflets

-scoliosis

4. Papillary

3. Rheumatic

3. Rheumatic

-kyphosis

muscle

fever

fever

-joint

dysfunction

4. Marfans

hypermobility

5. Atrial

syndrome

3. Marfans

Myxoma

*5. Aortic

syndrome

6. Infective

dissection/aortic

Endocarditis

aneurysm
*6. Trauma

Sympto
ms

Classic Triad:

*usually none

Acute:

(*acute causes)
Acute:

-dyspnea

Syncope

MVP+MR=

-dyspnea,

-dyspnea

-hemoptysis

Angina

-palpitations

fatigue, cough

-SOB

(blood backs up

Dyspnea/HF

-chest pain

-orthopnea

-orthopnea

into lungs)

-panic attacks

-paroxysmal

-chest discomfort

-SOB

nocturnal

Chronic:

Treatment:

syncope

dyspnea

-compensatory

-mitral

*V. fib

Chronic:

tachycardia

valvotomy

-exercise

-LV dilation

-mitral valve

*exertional

intolerance
-palpitations
-A. fib

replacement