crescendo/decrescendo. can't hear any of these changes

[aashkab]

hi

i can't hear any of the dang changes in the sounds of murmurs. i can only make it out if its systolic or diastolic. but as far as "crescendo, decrescendo" or "blowing" or something, i have no idea. and i've had questions where there really wasn't a hit in the stem whether it was AS or TR or something like that.

so my question is - on the real NBME, does the stem itself hint towards the murmur? at this point, i can only use the murmur sound as a supportive piece of info from my hunch in a stem. i definitely am not confident enough to just pick an answer based on the sound.

thanks.

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[Bond8204]

Yes, usually position and systolic/diastolic are enough to diagnose. They often give something else to indicate lung issue or radation to axilla or carotids.

 

[radiodoc99]

You will probably have enough information in the stem to select aortic stenosis or a regurgitation murmur. the audio clip is difficult to answer unless you listen to it a lot. boards and wards has a nice list.

 

[HTxFrog]

if you have an iphone, download iMurmur and play with it for 30 minutes and you'll be good. I really liked that program pretty well for a buck. If not there are tons of websites where you can listen to the difference. I know the Texas Heart Institute has a bunch of stuff on their website and there is a podcast you can get on iTunes by James Wilson from Texas Heart that has all of them and he explains what you should be listening for and everything. You just have to hear it a bunch of times but it isn't that hard once you know what you're looking for. You can start with mitral and tricuspid regurg b/c they are really easy. Its just whoosh, whoosh, whoosh, with no change in intensity whatsoever. Then you can compare AS to that and it really sounds a lot different.

 

[Domenech]

These changes can only be discerned with experience; something only cardiologists and medical specialists can do, not us mere mortal medical students

The information, location, and associated clinical symptoms are usually enough. I can't imagine any step1 examiner trying to act totally smart and give an isolated murmur. I bet even he'd find it difficult to interpret it without any other info.

 

[turkeyjerky]

i think one important thing to remember is whether the murmur obliterates the heart sounds. like with MS, they'll be a gap between S2 and the beginning of the murmur, in contrast to AR.

 

[aashkab]

i think one important thing to remember is whether the murmur obliterates the heart sounds. like with MS, they'll be a gap between S2 and the beginning of the murmur, in contrast to AR.

yeah that is true. but that's exactly what i'm talking about. i can't discern that difference with my dumbo sized ears. but yes, if you describe it verbally, i got it.

 

[badasshairday]

These changes can only be discerned with experience; something only cardiologists and medical specialists can do, not us mere mortal medical students

Yeah, I think it is really ridiculous. Now they even have it so we can move the stethescope to different parts of the chest on our own.

I don't know about you guys, but as an 2nd year medical student, my experience with auscultation is minimal. I barely was able to learn how to discern the difference between S1 and S2 during our clinical primer class. Also heard aortic stenosis on one of the standardized patients, which is probably one of the easier murmurs.

We freakin' learn how to listen to hearts during our clinical rotations. Stupid NBME.