Opening snap of mitral stenosis

Triple rhythm in mitral stenosis

1.Loud S1 2.Normal S2

3.Opening snap of mitral stenosis

Opening snap of mitral valve

Heart murmurs

Mechanism: turbulent blood flow in the heart

Causes:

•Valve abnormalities

•Rapid blood flow

•Low blood viscosity

Mechanisms of murmurs

Comissures between valvular leaflets => incomplete opening of the valves

area or enlargement of valvular orifice => blood regurgitation

Septal defects

blood velocity

blood viscosity

Description of murmurs

•Timing in the cardiac cycle (systolic, diastolic)

•Location

•Radiation

•Duration

•Intensity

•Pitch

•Quality (soft, rude)

•Relationship to respiration

•Relationship to body position

Grading the intensity of murmurs

•Grade 1 just audible with a good stethoscope in a quiet room

•Grade 2 quiet but readily audible with a stethoscope

•Grade 3 easily heard with a stethoscope

•Grade 4 a loud, obvious murmur with chest vibration

•Grade 5 very loud, heard not only over the precordium but elsewhere in the chest

•Grade 6: very loud, heard not only over the precordium but elsewhere in the body

Functional (innocent) murmurs

•Normal structure of the heart (valves)

•Only systolic

•Usually midsystolic

•Without radiation

•Quiet, soft

•Variable, short

Causes

•Fast blood flow o Fever

o Thyrotoxicosis

•Low viscosity

o Anemia

Functional murmurs