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Heart murmurs and Manuevers

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eesohbel's version from 2015-06-10 14:15

Quick Associations

Question Answer
Systolic crescendo/decrescendo murmursAS (to neck), MVP (click), HOCM
diastolic crescendo/decrescendoAR
holoystolic systolic murmursMR (to axilla), TR (inspiration), VSD (harsh)
holosystolic diastolic murmur MS (opening snap)
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Murmur Enhanced by

Question Answer
HOCMvalsalva (decreased venous return), sudden standing (Decrease preload)
MVP squatting, hand grip (increased TPR), vasalva (decreased venous return)
MRsquatting, hand grip (increased TPR), expiration ( increased LA return)
TRinspiration (increased RA return)
mitral stenosisincreased LA return
Hand grip increasesintensity of MR, AR, VSD
Hand grip decreasesHOCM
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Where Do You Hear Me

Question Answer
Aortic stenosisupper right sternal border
flow murmurupper right sternal border
aortic valve sclerosisright upper sternal boarder
pulmonic stenosisupper left sternal border
flow murmur (ASD)upper left sternal border
tricuspid regurglower left sternal border
tricuspid stenosislower left sternal border
apexmitral regurg
apexmitral stenosis
PDAleft intraclavicular area
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Splitting

Question Answer
Wide splittingdecreased ability of the RV to empty blood exaggerated delay in pulmonic valve closure in inspiration and expiration (abnormal)
Fixed splittingshunting of blood from left to right (ex. ASD) results in consistent delay in pulmonic closure. (A2 and P2 same gap in expiration and inspiration)
Paradoxical splittingdecreased ability of LV to empty blood results in delayed closure of aortic valve. (P2 comes before A2; and A2 and P2 are closer together in inspiration){
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Localization of a STEMI

Question Answer
LADV1-V4
LAD or LCXV5-V6
LCXI, aVL
RCAII, III, aVF
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Section 2

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