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

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)