Cardiac Auscultation

Front 1

ASD Sound, Location, Maneuver?

Back 1

Flixed Splitting of S2 with Systolic Ejection Murmur

Best heard in Pulmonic region

Front 2

Bicuspid Aortic Valve Sound, Location, Maneuver?

Back 2

Uneven Triplet (closer to S1) with systolic ejection murmur (stenosis)

Best heard in Aortic Region

DOES NOT CHANGE WITH MANEUVER (unlike mid systolic click)

Front 3

MVP Sound, Location, Maneuver?

Back 3

Mid systolic click = EVEN triplet; often with Late Systolic Murmur (often obscures S2)

Best heard at APEX (mitral)

Maneuver: Squatting makes it later (closer to S2); Valsalva makes it earlier (closer to S1

Front 4

HOCM Sound, Location, Maneuver?

Back 4

Late Peaking Systolic Ejection Murmur (similar to AS)

Location: Aortic (outflow tracts)

Maneuver: Decreased with squatting, increased with valsalva

Front 5

Aortic Stenosis Sound, Location, Maneuver?

Back 5

Late Peaking Systolic Ejection Murmur (may have paradoxical splitting S2).

Location: Aortic (outflow tracts)

Maneuver (opposite of HOCM): Increased with Squatting, decreased with Valsalva

Front 6

Papillary Dysfunction Sound, Location, Maneuver

Back 6

Late Systolic Murmur. Often obscures S2

Same murmur as: MVP, TVP, chordae rupture

Maneuver: Valsalva increases duration, decreases intensity (vice versa for squatting)

Front 7

Mitral Regurgitation Sound, Location, Maneuver?

Back 7

Holosystolic Murmur with constant intensity

Location: Apex with radiation to axilla

Maneuver: Decreased with Inspiration (vs TR and VSD)

Front 8

Tricuspid regurgitation S,L,M

Back 8

Holosystolic murmur, constant intensity from S1 to S2

Location: Tricuspid region

Maneuver: Increased with inspiration (vs MR and VSD)

Front 9

VSD S, L, M

Back 9

Holosystolic murmur, constant intensity from S1 to S2

Location: I think Apex?

Maneuver: NO change with inspiration (vs MR and TR)

Front 10

Acute Aortic insufficiency SLM

Back 10

Early short lived diastolic murmur. Musical!

Location: Either Aortic region or left sternal boarder

Maneuver: Increased by isometric hand grip

Front 11

Chronic Aortic Insufficiency SLM

Back 11

Holodiastolic murmur

Location: Aortic region

Maneuver: Isometric hand grip increases murmur

Front 12

Mitral Stenosis SLM

Back 12

Opening snap +/- late diastolic murmur. "What to dooo?"... More of an upbeat snap than a thud (like S3)

Location: Apex with DIAPHRAGM (vs S3)

No Manuever

Front 13

CHF with systolic dysfunction/ Volume Overload SLM

Back 13

S3 (Slooooo-shes-in); More of a thud than snap (vs opening snap). May have persistent S2 splitting

Location: Apex using BELL (vs OS)

Maneuver: None, may be brought on by exercise

Front 14

LVH (Atrial Kick) SLM

Back 14

Sound: S4 (A-stiff----heart)... THIS WILL BE INTERMITTENT ON THING!!!!!!!!

Location: Apex using bell

Front 15

Pericarditis SLM

Back 15

Sound: You miss this, you are retarded

Front 16

Fixed splitting of S2 in Pulmonic (possible SEM)

Back 16

ASD

Front 17

Early systolic ejection sound close to S1 (uneven triplet) in Aortic

Back 17

Bicuspid Aortic valve, Late peaking obstructive systolic ejection murmur if severe

Front 18

Late peaking systolic ejection murmur (increased with w/squatting, decreased with valsalva)

Back 18

Aortic Stenosis

Front 19

Mid systolic click (even triplet)

Back 19

MVP

Front 20

Late Peaking SEM (decreased w/squat, increased w/valsalva)

Back 20

HOCM

Front 21

Late Systolic Murmur (obscures S2)

Back 21

1) MVP - mid systolic click too
2) Papillary dysfunction
3) Cordae rupture

Front 22

Holosystolic murmur (constant from S1-S2).

Back 22

1) Mitral Regurgitation; At apex decreases with inspiration

2) Tricuspid regurgitation; at tricuspid region, increases with inspiration

3) VSD: no change with inspiration

Front 23

Early, short diastolic murmur along LSB or 2nd right interspace. Incrases with hand grip

Back 23

Acute AI

Front 24

Holodiastolic Murmur in 2nd right intercostal. Increases with hand grip

Back 24

Chronic AI

Front 25

Opening snap with "what to do...?" at Apex, using diaphragm

Back 25

Mitral stenosis

Front 26

Extra sound closer to S2 at apex with bell

Back 26

S3, systolic dysfunction/volume overload

Front 27

Extra sound closer to S1, intermittent; at apex using bell

Back 27

S4, Diastolic dysfunction