Overview
This lecture covers cardiac murmurs, their identification using a mnemonic, and related clinical cases, with a focus on systolic and diastolic murmurs and peripheral artery disease (PAD).
Cardiac Murmurs and Mnemonics
- "Mr. Peyton Manning is MVP" is a mnemonic for systolic murmurs.
- MR (Mitral Regurgitation), PM (Physiologic Murmur), AS (Aortic Stenosis), MVP (Mitral Valve Prolapse) are always systolic.
- "ARMS" helps remember diastolic murmurs: AR (Aortic Regurgitation), MS (Mitral Stenosis), always diastolic and always abnormal.
Steps to Murmur Identification
- Step 1: Is the murmur systolic or diastolic? Use the mnemonic.
- Step 2: Identify the valve/location where the murmur is loudest.
- Step 3: Know the classic symptoms associated with specific murmurs.
Clinical Cases Reviewed
- Aortic stenosis: Systolic murmur best heard at the aortic listening point; presents with chest pain, syncope, heart failure.
- Mitral regurgitation: Systolic murmur at the apex.
- Physiologic murmurs: Common in growing adolescents, benign, due to heart growth and stretching.
- Aortic regurgitation: Diastolic murmur, always abnormal, heard loudest at the 2nd right intercostal space.
- Mitral stenosis: Diastolic murmur best heard at the apex, not radiating to the neck.
Peripheral Artery Disease (PAD)
- Intermittent claudication is a key symptom; associated with PAD.
- Weakened peripheral pulses are a significant finding.
- Major risk factors: diabetes, smoking, dyslipidemia, inactivity.
Medication Side Effects
- Amlodipine commonly causes lower extremity edema; the effect is dose-related.
Key Terms & Definitions
- Systolic murmur — murmur occurring during heart contraction.
- Diastolic murmur — murmur occurring during heart relaxation.
- Peripheral artery disease (PAD) — a condition of narrowed arteries reducing blood flow to limbs.
- Intermittent claudication — pain from too little blood flow during exercise, relieved by rest.
- Physiologic murmur — benign heart murmur due to growth or increased blood flow, often in children/adolescents.
Action Items / Next Steps
- Memorize "Mr. Peyton Manning is MVP" and "ARMS" for murmur identification.
- Practice identifying murmurs using steps 1 and 2.
- Review risk factors and symptoms for PAD.
- Complete any related practice questions or case reviews.