Lecture on Heart Auscultation and Murmurs

Key Auscultation Sites and Mnemonics

• Auscultation Sites:
  • Aortic Area: Right 2nd intercostal space
  • Pulmonic Area: Left 2nd intercostal space
  • Tricuspid Area: Left 4th intercostal space
  • Mitral Area (Apex): Mitral area
• Mnemonic: AP TM (Apartment M) to remember the order of auscultation areas.

Identifying Heart Murmurs

• Steps to Identify Murmur:
  1. Determine if the murmur is systolic or diastolic.
  2. Identify the location of the murmur.
• Example Case Analysis:
  • 78-year-old male with dyspnea on exertion and angina.
  • Systolic murmur heard in apical area indicates mitral regurgitation.

Understanding Systole vs. Diastole

• Mitral Valve Function:
  • Diastole: Blood flows from left atrium to left ventricle.
  • Systole: Blood ejected from left ventricle; potential regurgitation if mitral regurgitation occurs.

Maneuvers and Murmurs

• Inspiration vs. Expiration:
  • Inspiration: Right-sided murmurs get louder.
  • Expiration: Left-sided murmurs get louder.
• Preload and Afterload Effects:
  • Increase Preload: Murmurs generally get louder except in hypertrophic obstructive cardiomyopathy (HOCM) and mitral valve prolapse (MVP).
  • Decrease Preload: Decreases murmur intensity except in HOCM and MVP.
  • Increase Afterload: Louder regurgitant murmurs, softer HOCM and MVP.
  • Decrease Afterload: Louder HOCM and MVP.

Association and Mnemonics for Common Murmurs

• Aortic Stenosis:
  • Crescendo-decrescendo murmur.
  • Mnemonic: SAD (Syncope, Angina, Dyspnea), radiates to carotids.
  • Often seen in older individuals or with calcified valves.
• Mitral Regurgitation:
  • Holosystolic murmur.
  • Associated with rheumatic fever.
  • Mnemonic: RuMitral (Rheumatic -> Mitral).
  • Radiates to the axilla.
• Tricuspid Regurgitation:
  • Holosystolic murmur.
  • Mnemonic: "Do you want to try some drugs?" (Associated with IV drug use).
• Mitral Stenosis:
  • Opening snap characteristic.
  • Mnemonic: "Operating System is Microsoft" = OS is MS.
• HOCM:
  • Louder with decreased preload/afterload.
  • Family history of sudden cardiac death is a clue.
• Mitral Valve Prolapse:
  • Mid-systolic click.
  • Mnemonic: "To win MVP your team has to click."
  • Associated with young women with psychiatric history.

Additional Notes

• Exceptions to preload/afterload rules are high-yield.
• Understanding maneuvers and their effects is crucial for exams.
• Use mnemonics for quick recall on exam questions regarding murmurs.