Heart Murmurs From Scut Monkey

Front 1

Aortic stenosis (AS)

Back 1

Systolic (medium-pitched) crescendo–decrescendo murmur with radiation to the carotid arteries. A2 decreased, ejection click and S4 often heard at apex. Paradoxical splitting of S2. Narrow pulse pressure and delayed carotid upstroke and left ventricular hypertrophy (LVH) with lift at apex.

Front 2

AS heard best

Back 2

second intercostal space

Front 3

Aortic insufficiency (AI)

Back 3

Diastolic (high-pitched) decrescendo murmur. Often with LVH. Widened pulse pressure, bisferious pulse, Traube sign, Quincke sign, and Corrigan pulse may be seen with chronic aortic insufficiency. S3 and pulsus alternans often present with acute aortic insufficiency.

Front 4

AI heard best

Back 4

Left lower sternal border at third and fourth interspace with patient sitting up, leaning forward and fully exhaled

Front 5

Pulmonic stenosis (PS)

Back 5

Systolic crescendo–decrescendo murmur. Louder with inspiration. Click often present. P2delayed and soft if severe. Right ventricular hypertrophy (RVH) with parasternal lift.

Front 6

Pulmonic stenosis / insufficiency heard best

Back 6

left second intercostal space

Front 7

Pulmonic insufficiency (PI)

Back 7

Diastolic decrescendo murmur. Louder with inspiration. RVH usually present.

Front 8

MS heard best

Back 8

Localized at the apex

Front 9

Mitral stenosis (MS)

Back 9

Diastolic (low-pitched rumbling sound) murmur heard best with the bell in the left lateral decubitus position. With increased or decreased S1. Opening snap (OS) heard best at apex with diaphragm. Increased P2, right-sided S4, left-sided S3 often present. RVH with parasternal lift may be present.

Front 10

Mitral insufficiency (MI)

Back 10

Holosystolic (high-pitched) murmur with radiation to axilla. Soft S1, may be masked by murmur. S3 and LVH often present. Midsystolic click suggests mitral valve prolapse.

Front 11

Tricuspid insufficiency heard best

Back 11

Left lower sternal border

Front 12

Tricuspid insufficiency (TI)

Back 12

Holosystolic (high-pitched) murmur. Increases with inspiration. Right-sided S3 often present. Large V wave in jugular venous pulsations.

Front 13

ASD heard best

Back 13

Left upper sternal border

Front 14

Atrial septal defect (ASD)

Back 14

Systolic (medium-pitched) murmur. Fixed splitting of S2 and RVH, often with left- and right-sided S4.

Front 15

VSD heard best

Back 15

Left lower sternal border

Front 16

Ventricular septal defect (VSD)

Back 16

Harsh holosystolic (high-pitched) murmur. S1 and S2 may be soft.

Front 17

PDA heard best

Back 17

Left first and second ICS

Front 18

Patent ductus arteriosus (PDA)

Back 18

Continuous, machinery (medium-pitched) murmur. Increased P2 and ejection click may be present.

Front 19

Third heart sound (S3)

Back 19

Early diastolic sound caused by rapid ventricular filling. Left-sided S3 seen normally in young people, also pregnancy, thyrotoxicosis, mitral regurgitation, and congestive heart failure.

Front 20

Fourth heart sound (S4)

Back 20

Late diastolic sound caused by a noncompliant ventricle. Left-sided S4 seen with hypertension, aortic stenosis, and myocardial infarction. Right-sided S4 seen with pulmonic stenosis and pulmonary hypertension.

Front 21

S3 / S4 heard best with bell or diaphragm

Back 21

Bell

Front 22

S4 heard best

Back 22

Left-sided S4 heard at apex, right-sided S4 heard at left lower sternal border.

Front 23

S3 heard best

Back 23

Left-sided S3 heard at apex, right-sided S3 heard at left lower sternal border.