Cardiac Lesions and Severe Clinical Signs
AORTIC STENOSIS
- Slow rising pulse
- S4
- Paradoxical splitting of the second heart sound
- Aortic thrill
- Length and harshness of murmur
- LVH – displaced apex beat
- LVF – a late sign
MITRAL STENOSIS
- Small pulse pressure
- Loud first heart sound (can become soft if heavily calcified or immobile valve leaflets)
- Early opening snap
- Long diastolic murmur
- Diastolic thrill @ apex
- PHT signs
MITRAL REGURGITATION
- Small volume pulse
- Displaced forceful apex
- Pansystolic murmur -> axilla
- S3
- Soft S1
- A2 early
- Early diastolic rumble
- AF
- LVF signs
AORTIC REGURGITATION
- Collapsing pulse
- Wide pulse pressure
- Long decrescendo diastolic murmur
- S3
- Soft A2
- Austin Flint murmur (low pitched rumbling mid-diastolic and presystolic murmur @ apex)
- LVF
MITRAL VALVE PROLAPSE
- Click -> high pitched late-systolic murmur extending throughout systole
- See also Barlow syndrome
TRICUSPID REGURGITATION
- JVP: Large v-waves, elevated
- Right ventricular heave
- Pansystolic murmur @ the lower sternal edge (increases with inspiration)
- Large, pulsatile liver
- Ascites
- Peripheral oedema
PULMONARY STENOSIS
- Ejection systolic murmur peaking late in systole
- Absent ejection click
- S4
- RVF signs
ASD
- wide fixed splitting of S2
- mid diastolic flow murmur over tricuspid area (when significant shunt present)
VSD
- harsh pansystolic murmur @ left sternal edge
- systolic thrill
- mid diastolic flow murmur over mitral area (when significant shunt present)
PATENT DUCTUS ARTERIOSUS
- continuous murmur over pulmonary area
- mid diastolic flow murmur over mitral area (when significant shunt present)
References
- Robbins A, Zhang G, Cadogan M. Eponymic Cardiac Murmurs. LITFL
- Nickson C. Murmurs DDx. CCC
- Cadogan M. Echo Library. LITFL
- Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e72-e227.
- Otto CM. Textbook of Clinical Echocardiography. Elsevier. 7e, 2023.
- Houghton AR. Making Sense of Echocardiography: A Hands-on Guide. 3e 2023
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC