Prosthetic Valve

Heart Sounds & Murmurs

General clues

• Mitral lesions can radiate to the axilla.
• Tricuspid and pulmonary lesions can radiate to the back.
• Aortic lesions can radiate to the neck.

Mitral stenosis (high yield)

• often rheumatic
• complications: AF, thromboembolism
• features: loud S1, opening snap after S2, diastolic rumble

Mitral regurgitation (high yield)

• causes: IHD, HTN, HF, rheumatic
• pansystolic murmur radiating to axilla
• chronic severe MR can have high LVEF; “normal” LVEF can actually indicate LV dysfunction in severe MR

Mitral valve prolapse

• mid-to-late systolic click, late systolic murmur; worse with Valsalva/standing, better with squatting

usually presents with dyspnea on exertion

Clues to Dx: