TYPE OF MURMURS

10:03:00 AM

Long case exam is just in few hours from now and I'm so nervous about it. What if I got stroke patient? OMGG me,myself will be having stroke in front of the patient. I hope Dr. Ong will give me a straightforward case and I'm able to tackle that case too, in shaa Allah. Ease all my journey today ya Rabb.

So last night I was revising about CVS examination and got confused all over the topics. Like, WTH am I reading for the past 1 hour then got forgot again. Allahu my brain... *sigh*

Having difficulty in differentiating type of murmurs while auscultate a patient? Don't worry, you're not the only one ! Me too having the same problem since I was a 3rd year medical student. During that time, I was at Hospital Tanah Merah and I did not came across any patient with murmur. Cases were limited as it is a district hospital. All severe cases will be referred to Hospital Kota Bharu. So, I'm here now in Kota Bharu as a 4th year medical student. So many patient with interesting physical findings and most of them have murmur! YAY.

So here some tips I learnt from my prof and also from hospital specialist. One of my prof blog about it - A Simplified Approach to Cardiac Murmurs For Medical Students. And it is very helpful for me and makes my life easier. A bit confused in beginning but later you'll be okay.

From the blog:

The basic principles are:

if the murmur coincides with the first heart sound, it is a systolic murmur.

If it doesn't coincide with the first heart sound, it is a diastolic murmur.

Sometimes, even if you have done your best and listened while palpating the pulse, and you are still not sure whether it is a systolic or diastolic murmur, well, in the exams, you can guess and you have a fifty-fifty chance of getting it right (or wrong).

If you had to guess, then go for systolic murmurs as they tend to be:

more common
easier to hear compared to diastolic murmurs which tend to be low-pitched

Of course when guessing, there is a chance one might be wrong. Rather have no answer, sometimes it is better to guess.

For the sake of simplification, I memorised, as a medical student, four of the more common murmurs:

Mitral regurgitation
Aortic stenosis
Mitral stenosis
Aortic regurgitation

Here the best part about my prof. She summarised it all like this:

Mitral regurgitation is a pansystolic murmur that is heard loudest at the apex, heard through out the praecordium, radiates to the axilla, and is accentuated by expiration.

Aortic stenosis is an ejection systolic murmur heard loudest at the aortic area, radiates to the carotids, and in accentuated by the patient leaning forward in expiration.

Mitral stenosis is a mid-diastolic rumbling murmur heard at the apex and accentuated with the patient leaning on the left side in expiration.

Aortic regurgitation is an early-diastolic murmur heard best at the left sternal edge/tricuspid area, accentuated by the patient leaning forward in expiration.