Page 334 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

290 SECTION III CARDIOvASCuLAR ``CARdIOvASCulAR—PHYSIOlOGY CARDIOvASCuLAR ``CARdIOvASCulAR—PHYSIOlOGY

Auscultation of the heart

Where to listen: APT M
Aortic area:
Systolic murmur
Aortic stenosis Pulmonic area:
Flow murmur 1 1 1 Systolic ejection murmur
(eg, physiologic murmur) Pulmonic stenosis
Aortic valve sclerosis Atrial septal defect
2 Flow murmur
Left sternal border: A P
Diastolic murmur 3 Tricuspid area:
Aortic regurgitation Holosystolic murmur
(valvular) 4 Tricuspid regurgitation
Pulmonic regurgitation Ventricular septal defect
Systolic murmur 5 T Diastolic murmur
Hypertrophic Tricuspid stenosis
cardiomyopathy M
Aortic 6 Mitral area (apex):
Pulmonic Holosystolic murmur
Tricuspid 7 7 7 7 7 7 7 Mitral regurgitation
Mitral
Systolic murmur
Mitral valve prolapse
Diastolic murmur
Mitral stenosis
MANEuvER CARdIOvASCulAR CHANGES MuRMuRS THAT INCREASE WITH MANEuvER MuRMuRS THAT dECREASE WITH MANEuvER
Standing Valsalva  preload ( LV volume) MVP ( LV volume) Most murmurs ( flow through
(strain phase) HCM ( LV volume) stenotic or regurgitant valve)
Passive leg raise  preload ( LV volume)
Most murmurs ( flow through MVP ( LV volume)
Squatting  preload,  afterload ( LV stenotic or regurgitant valve) HCM ( LV volume)
volume)
Hand grip  afterload Ž  reverse flow Most other left-sided murmurs AS ( transaortic valve pressure
across aortic valve ( LV (AR, MR, VSD) gradient)
volume) HCM ( LV volume)
Inspiration  venous return to right heart, Most right-sided murmurs Most left-sided murmurs
 venous return to left heart

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