Introduction to Cardiac Auscultation

Posted by e-Medical PPT
Valvular Aortic Stenosis
Failure of valve to open normally during systole, requiring LV to develop excess pressure to overcome increased resistance.
Pressure gradient between LV and aorta may be as much as 100 mm Hg causes concentric hypertrophy
Symptoms of exertional chest pain, syncope, dyspnea
Mandate valve replacement to prevent sudden death
Murmur in AS is mid-systolic, crescendo-decrescendo.

Mitral Stenosis
Almost always rheumatic in origin
Murmur may be subtle, but high flow states cause increased pressure gradient, pulmonary edema
Classic presentation is during vaginal delivery. Tachycardia, straining, volume increase cause pulmonary edema
Patients eventually have exertional dyspnea, atrial fibrillation (often with thromboembolism), chest pain

Normal MVA 4-5 cm2
More than 2.5 cm2 asymptomatic
Less  than 1.5 cm2 may have sxs at rest
Stress which increases transmitral flow or decreases diastolic filling time will significantly increase gradient

Turbulent, high velocity flow occurs during diastole
murmur is therefore a DIASTOLIC, low frequency rumble heard at apex with stethoscope bell, patient in L lateral decubitus
requires quiet concentration, palpate carotid to time systole/diastole
Always look for MS in patient with new Atrial fibrillation
rate control, anticoagulation crucial

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