Murmurs
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| Mitral Regurgitation | left sided heart failure, increase with expiration, problem closing valve during systole; holosystolic high pitched "blowing murmur" loudest at apex; MVP most common radiates to axilla
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| Tricuspid Regurgitation | right sided heart failure; increase with inspiration; problem closing valve during systole; holosystolic high pitched "blowing murmur"; increase preload; best heard at left parasternal border, IV drug user; carcinoid heart disease; pulsatile liv
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| Aortic Regurgitaion | Problem in closing diastole; increase LV EDV = increase frank starling mechanism; drop in diastolic pressure; "immediate high pitched blowing murmur"; involuntary head bobbing; isolated aortic valve root dialation
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| Mitral Stenosis | problem opening valve in diastole, recurrent attacks of rheumatic fever; narrowing of mitral valve orifice; LA becomes dilated (due to increase ventricular feeling)>>>LV increase in PCWP =LA pressure; Low pitched mid to late diastolic rumble at apex. Open
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| Tricuspid Stenosis | Problem opening valve in diastole; low pitched diastolic murmur often confused with MS; Murmur louder in inspiration which differentiates from MS
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| Aortic stenosis | problem opening valve in systole; common cause of calcification of bicuspid valve; age related sclerosis valve; chronic RF; crescendo decrescendo murmur, radiates to carotids and apex; pulse weak compared to heart sounds "pulsus parvus et tardus' Diamond
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| MVP[mitral valve prolapse] | late systolic murmur with midsystolic click; myoxamaotous degeneration of mitral valve leaflets "floppy valves" decrease preload --> hear S1 sound ; increase in preload--> hear S2 sound
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| ASD | diastolic: wide fixed split S2 and loud S1; midsystolic ejection murmur, tricuspid rumble
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| VSD | Harsh holosystolc murmur heard diffusely over the pericardium maximally
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| PDA | Continous machine murmur heard at 2nd left space
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| Opens during systole Closes in diastole | Aortic and Pulmonic
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| Opens in diastole and closes in systole | Mitral and Tricuspid
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| Regurgitations | problems closing valves
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| Stenosis | Problems in stenosis
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