Download Regurgitant Systolic Murmurs Chatper 15

Regurgitant Systolic Murmurs
Chapter 15
Are G. Talking, MD, FACC
Instructor
Patricia L. Thomas, MBA, RCIS
Outline
•
•
•
•
•
•
•
Mitral Regurgitation
Tricuspid Regurgitation
Ventricular Septal Defect
Patent Ductus Arterious
Acute Ventricular Septal Perforation
Papillary Muscle Rupture
Mitral Valve Prolapse Syndrome
Introduction
• Regurgitant Murmurs are caused by
retrograde flow across AV valves
• TR heard at the lower left sternal border
• MR heard at the apex
• Holosystolic Murmurs suggest MR, TR,
VSD’s
Chronic Mitral Regurgitation
• Continues as long as LV
pressure > that of the
enlarged LA
• Begins at S1 and extend
through S2
• Large high pitched,
blowing
holosystolic/pansystolic
murmur
Acute Mitral Regurgitation
• Loud Grade IV or >,
diamond shaped
• Pressure in the normal
nondilated LA increases
rapidly because of
regurgitant flow in early
systole and = LV
pressure in late systole
Mitral Regurgitation Causes
•
•
•
•
•
•
Rheumatic Heart Disease
Papillary Muscle Dysfunction
Mitral Valve Prolapse
Rupture Chordae Tendineae
Calcified mitral Annulus
LV Dilatation
Tricuspid Regurgitation
• The holosystolic murmur of MR engulfs A2
but stops before P2 whereas the murmur of
TR persists through and engulfs P2
• Increases with inspiration (Carvallo sign) &
does not radiate well to the axillary region
• Mild TR
– Infective Endocarditis
seen with IV drug abuse
may be mid-systolic of
low intensity, heart only
with inspiration
– S4 may be present
• Advance TR
– May not increase with
inspiration or may be
absent
– Tricuspid honk or
whoop (highly
musical)
Causes
• Tricuspid Insufficiency is commonly secondary to
dilatation of the right ventricle
• Severe Right Heart Failure secondary to mitral
stenosis
• Pulmonary Heart Disease with pulmonary
hypertension
• Congenital deformity (Epstein's Anomaly),
Rheumatic Valve disease, or Infective
Endocarditis
• Listen with the diaphragm of the stethoscope
along the lower left sternal border (third
interspace)
Ventricular Septal Defect
• Holosystolic, loud, & harsh; S2 is loud & widely
split; possible palpable thrill
• Begins with ventricular systole S1, when the rise
in LV pressure exceeds that of the RV & continues
until S2 when left ventricular pressure falls
• Listen with the diaphragm of the stethoscope from
the mid-to lower left sternal border
• Patent Ductus Arteriosus
– Continuous murmur
• Acute Ventricular Septal Perforation
– Caused by acute MI
– Loud short systolic murmur, grade IV
– Listen with diaphragm of stethoscope
• Papillary Muscle Rupture
– mid-to late systolic murmur, thrill
– Listen with diaphragm for the stethoscope
Mitral Valve Prolapse Syndrome
• Mid-to-late systolic, late systolic, or holosystolic
• Moderate Prolapse
– 1/3 or ½ into systole & increases its intensity until A2
– Valve is competent in early systole & prolapse in LA in
late systole
• Severe Prolapse
– Loud S1, holosystolic murmur
– Fusion of a click with S1, Sound is louder
• Click
– In < ½ of patients marks onset of the murmur “click
murmur syndrome”
• Cause
– Mitral insufficiency
THE END
OF
CHAPTER 15
Tilkian, Ara MD Understanding Heart Sounds and Murmurs,
Fourth Edition, W.B. Sunders Company. 2002, pp. 180-196