HeartmurmursDynamicAuscultation.ppt

Connection b/w high pressure chamber/vessel low pressure chamber/vessel From the aorta a. Persistent ductus arteriosus b. Aorto-pulmonary window c. RSOV From the coronary artery: Coronary arteriovenous fistulae draining into RA, RV, PA ALCAPA Other arteriovenous communications Broncho-pulmonary collaterals Chest wall arteries–pulmonary vessels Peripheral A-V Fistula Others Lutembacher syndrome with restricted ASD PDA Gibson’s murmur At 1 or 2 LICS NR- high frequency soft murmur peaks around S2 Mod R- loud coarse machinery murmur with eddy sounds SEVERITY PDA with no continuous murmur Neonates- due to high PVR Very small ductus Very large ductus large VSD- due to equalization of pulm and sys Pr PAH- first dia component goes, then sys AS, CoA- due to low aortic pressure Continuous murmurs APW 2 or 3 LICS Usually associated with early devp of eissenmenger RSOV No peaking at S2 seen [peaks in sys or dia.] To RA- RLSB RV- LLSB RVOT- 3 LICS Lutembacher syndrome with restricted ASD LLSB [body of RA] Continuous murmurs C-AVF RA- RLSB or RUSB CS- back b/w spine Lt scapula RV inflow- LLSB RVOT- Upper to Mid LSB [beat to beat change in murmur may be present, RV systolic compression, valsalva softens murmur] PA- ULSB [no eddy sounds] ALCAPA Murmur louder in diastole [LV contr. I/C flow] Do not peak at S2 Usu LUSB or RUSB LA- ULSB rad to Lt ant ax line - Lt SVC- upper to mid LSB Disturbance in flow patterns in arteries AV Fistula Murmur heard in the venous side Due to rapid blood flow- cervical venous hum, mammary soufflé, hyperthyroidism, hemangioma, hyperemia of neoplasm (HCC, RCC, Paget’s disease) Stenosed arteries with inadequate distal collaterals aortic arch vessel occlusions, atherosclerotic carotids, coarctation of aorta, main pulmonary artery stenosis and periph pulmonary artery stenosis Disturbances in flow patterns in veins Venous hum Healthy children, young healthy adults, pregnancy Sitting, Bell, medial aspect of Rt SCl fossa, with fa