Cardiac auscultation

CARDIAC AUSCULTATION Murmurs and DDx: [+] present, [-] absent [-] systolic murmur [-] pansystolic - mitral incompetence - tricuspid incompetence - ventricular septal defect - papillary muscle dysfunction (left or right ventricle) [-] midsystolic - aortic stenosis - pulmonary stenosis - pulmonary flow murmur - atrial septal defect [-] late systolic - mitral valve prolapse - papillary muscle dysfunction - hypertrophic obstructive cardiomyopathy (hocm) [-] diastolic murmurs [-] early diastolic - aortic incompetence - pulmonary incompetence [-] mid-diastolic - mitral stenosis - tricuspid stenosis - atrial myxoma - Austin Flint aortic incompetence murmur [-] presystolic - mitral stenosis - tricuspid stenosis - atrial myxoma [-] continuous murmurs - patent ductus arteriosus - venous hum - arteriovenous fistula - coarctation of the aorta [-] combined murmurs (simulating a continuous murmur) - aortic stenosis + aortic incompetence - mitral incompetence + aortic incompetence Abnormal sounds and DDx: [-] loud S1 - tachycardia - hyperdynamic states - fever - thyrotoxicosis - anaemia - mitral stenosis [-] soft S1 - mitral regurgitation - acute myocardial infarction - cardiomyopathy - hypothyroidism [-] pathological splitting of s1 - right bundle branch block [-] loud S2 [-] loud A2 - systemic hypertension - systemic atherosclerosis [-] loud P2 - pulmonary hypertension [-] soft S2 - aortic stenosis - pulmonary stenosis - aortic regurgitation [-] reverse splitting - left bundle branch block [-] extra sounds (S3, S4) - physiological in the young - left or right ventricular failure - acute myocardial infarction - left ventricular hypertrophy

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Examination Notes

Valve sound areas:

• Mitral → cardiac apex
• Tricuspid → 5th intercostal space, left sternal edge
• Pulmonary → 2nd intercostal space, left sternal edge
• Aortic → 2nd intercostal space, right sternal edge

DDx Cardiac Valve Abnormalities

• Rheumatic fever
• Atherosclerosis
• Congenital bicuspid aortic valve
• Bacterial endocarditis
• Dissecting aortic aneurysm
• Cardiac trauma
• Syphilis (tertiary)
• Systemic autoimmune disorders
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Systemic lupus erythematosus
• Connective tissue disorders
  • Ehlers-Danlos syndrome
  • Marfan syndrome

Related items

• Cardiovascular system