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Intensity

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Intensity is graded on a 6 point scale

r Grade 1 = very faint


r Grade 2 = quiet but heard immediately
r Grade 3 = moderately loud
r Grade 4 = loud with thrill
r Grade 5 = heard with stethoscope partly off the chest
r Grade 6 = no stethoscope needed

Grade of more than 4 is associated with thrill.


mitch ² The frequency of the murmur determines the pitch,
high or low

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onfiguration ² The time course of murmur intensity
corresponds to the "shape" of a diagram

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m 1   2

3 1   2

m 4 1   4    


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  1      2
Kocation h
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Timing ² The duration of a murmur is assessed by the length of
systole or diastole that the murmur occupies


Systolic murmurs
- 1 7  2
8 1  2
9  
:  

Diastolic murmurs
9   
-4  
:   1 2
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Systolic murmurs ²

A systolic murmur starts with or after S1 and terminates before or


at S2
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] ection systolic murmur
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'*    crescendo decrescendo (DIAMOND
SHAm]D)   


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mauses of ]SM


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Aortic stenosis &   
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mauses

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Holosystolic murmur/ mansystolic murmur

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% timing and duration of holosystolic murmurs & (  &   
 MR

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Mitral valve prolapse h -  ! !      
   

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The murmur is heard as a whoop" or "honk," which is a high-


frequency, musical, loud, and widely transmitted murmur, can
appear intermittently in some patients with mitral valve prolapse
and may be precipitated by a change of posture.

mapillary muscle dysfunction


Tricuspid valve prolapse
Diastolic murmurs h i    '    
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]ARK DIASTOKIm MURMURS ²

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Two common causes


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The murmur of aortic regurgitation

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Tricuspid stenosis h
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Atrial myxoma h
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Austin Flint murmur ² An apical diastolic rumbling murmur has


been described in patients with pure aortic regurgitation

%  


<     ! !   &   
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     !    ! ! 4
     '*   functional mitral
stenosis



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marey-moombs murmur ²

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Two causes


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< 4 !  &.  &   m 4
m&

montinuous murmur ²
A continuous murmur begins in
systole and continues to diastole without
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˜achycardias Atrial rates Ventricular rates Regularity Onset and termination

Sinus tachycardia 100 to 150 100 to 150 Regular gradual


Paroxysmal reentrant 140 to 200 140 to 200 Usually regular abrupt
supraventricualr
tachycardia
Paroxysmal automatic 100 to 180 100 to 180 Usually regular Usually abrupt
atrial tachycardia
Paroxysmal atrial 100 to 250, usually Variable Regular or Gradual
tachycardia with block 120 to 180 with 2:1 irregular
block
Multifocal atrial 100 to 180 100 to 180 Irregular gradual
tachycardia
Atrial flutter 220 to 350 Variable Regular or abrupt
irregular
Atrial fibrillation >350 Variable Irregular abrupt
Paroxysmal automatic 100 to 180 with AV 100 to 180 Regular Usually abrupt
AV-junctional dissociation,
tachycardia usually NSR
Paroxysmal ventricular With AV 140 to 200 Regular or abrupt
tachycardia dissociation, slightly irregular
usually NSR
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Atrial Atrio- Circus Ventricular
fibrillation ventricular movement tachycardia
nodal tachycardia/
tachycardia atrial
tachycardia
Blood Variable Fixed Fixed Variable
pressure
Heart sounds Variable Fixed Fixed Variable
Arterial Irregular Regular Regular Regular
pulsations
Jugular Absent Frog+ Frog- Cannon
pulsations waves
= s 4)  & 
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o -  !     
= > 4&.
o = ?m*im
= m 4 &.

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