TimingTimingLesionManeuvours to accentuate murmurAortic area clavicles carotids also apex Aortic StenosisSquatting Leg raise Sitting in full Exp Pulmonary StenosisMid systolic EjectionAtrial Septal D ID: 880182
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1 Timing Timing Position where murmur is b
Timing Timing Position where murmur is best heard Lesion Maneuvours to accentuate murmur Aortic area, clavicles & carotids, also apex Aortic Stenosis Squatting. Leg raise. Sitting in full Exp Pulmonary Stenosis Mid systolic (Ejection) Atrial Septal Defect Lower LSE (4-5th IC spaces) & apex Hypertrophic Cardiomyopathy Accentuated on Standing. Valsalva Atrial Septal Defect Aortic or Pulmonary areas Anaemia, Thyrotoxicosis, Pregnancy Systolic Lower LSE & apex Hypertrophic Cardiomyopathy Accentuated on Standing. Valsalva Late Systolic Apex Mitrial Valve Prolapse Earlier & louder with Valsalva Left Sternal edge Coarctation of the Aorta Pansystolic Apex to Axilla Mitrial Regurg (blowing, high freq) Squatting, leg raise, hand grip Left Sternal edge Tricuspid Regurg (low pitched) Ventricular Septal Defect Early Diastolic LSE (3-4th IC spaces) & Apex Aortic Regurg (blowing, high pitched) Sitting forward in full expiration Right (or Left) Sternal edge Pulmonary Regurg Inspiration Murmur Apex Mitral Stenosis (low freq, rumbling) Left lateral position Diastolic Mid Diastolic Austin Flint (aortic regurg) Left Sternal edge Tricuspid Stenosis Late Diastolic Apex Mitral Stenosis Left lateral position (Presystolic) Left Sternal edge Tricuspid Stenosis Atrial Myxoma Left 1st or 2nd IC space Midclav line Patent Ductus Arteriosis A V Fistula Continuous Entire Cardiac Cycle Aorto-pulmonary Fistula Venous Hum in Children Decreased by occluding vein or by Bell (Low pitched) Diaphragm (High pitched lying child flat Mitral stenosis Aortic regurg Austin Flint Mitral valve prolapse Tricuspid stenosis Pulmonary regurg Remember R.I.L.E Inspiration Left Sternal Edge (3-4th IC spaces)