Easily Remember Specific Pulses and Murmurs in Different Heart Conditions

Opening Snap seen in MS.

Pericardial Knock is heard in Constrictive Pericarditis.

Fixed Split seen in ASD.

Paradoxical Split=Reverse Split, happens when A2 happens after P2 due to -HTN, LBBB, AS.

S3 is heard in CHF, TR, Chronic MR, PDA. S3 is heard normally in Kids and during Pregnancy.

S4 is heard in Ischemia, LVH, HOCM, AS, Acute MR.

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PULSES:

Pulsus Tardus is seen in AS [Tip to remember: Pulsus TordAS ]

Pulsis Paradoxus is seen in Cardiac Tamponade, SVC obstruction, Pulmonary Obstruction. [Tip to remember: TamponParade]

Pulsus Bisferiens is seen in HOCM. [Tip to remember:?]

Pulsus Alternans [one strong alternates with one weak beat] is seen in Heart Failure.

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MURMURS:

  1. [MDM] Mid Diastolic Murmurs are due to MS, ASD, TS.

2. [HSM] Holo Systolic Murmurs are due to MR, VSD, TR.

3. [MSM] Mid Systolic Murmurs are due to AS, PS.

4. [EDM] Early Diastolic Murmurs are due to AR, PR.

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Late Diastolic Murmur: Atrial Myxoma.

Late Systolic Murmur: MVP.

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Mid Diastolic/Systolic Murmurs are due to STENOSIS.

Early/Holo Diastolic/Systolic Murmurs are due to REGURGITATION.

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Inspiration increases Blood flow to Right side of the Heart and so Right murmurs increase with Inspiration.

Expiration increases Blood flow to Left side of the Heart and so Left murmurs increase with Expiration [except HOCM and MVP].

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Valsalva maneuver increases Pressure in lungs and so Blood volume is less during Valsalva. When Blood flow to heart is less, murmur is loud is HOCM and Less loud in AS.

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Murmur Intensity is determined by Volume of Blood passing through the openings/valves and Back Pressure towards heart by for example HTN, hand grip etc..

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Ischemia can cause Mitral Regurgitation causing Systolic Murmur at apex radiating to Left Axilla.

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Severe Aortic Regurgitation can cause [Mid Diastolic Murmur like in Mitral Stenosis] Austin Flint Murmur. [Tip to remember: ARstin Flint murmur]

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