Mitral v aortic stenosis

[blueboyscholar]

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They sound the same to me. Is it just me? Any advice on getting better at heart sounds? Anyone listen to them at 1/2 speed or something? (And no, I would not ask compound questions like this while doing a pt interview 😀)

 

[Step1Hash]

They sound the same to me. Is it just me? Any advice on getting better at heart sounds? Anyone listen to them at 1/2 speed or something? (And no, I would not ask compound questions like this while doing a pt interview 😀)

For the test I think the biggest thing will be when you move the stethoscope around and hear the MS loudest at the axilla. I know that AS can be heard at both the Right-2nd intercostal space as well as the axilla but the MS will only really be heard well at the axilla. Also what helps me with hearing murmurs is figuring out when systole and when diastole is. Systole is shorter than diastole so if the murmur duration is shorter than the time of silence you know its a systolic murmur...and vice versa. I usually tap my fingers on the table to time S1/S2 to help me visualize the timings.

Hope this helps.

 

[da8s0859q]

Lots of little things to this. As long as you get used to picking out S1 and S2 -- as in, can easily tell systole from diastole -- you can rule out half of the options on what a rhythm is. Lub-DUB. S1-S2. Diastole is ~2x longer than systole, so that's the easiest way to tell. Then it's just pattern matching. Definitely drum on the desk or conduct or whatever helps.

AS is systolic, best heard over the right 2nd ICS, and radiates to the carotids; MS is diastolic, best heard over the left 5th MCL, and doesn't really radiate.

Probably overkill... but I thought Goljan did a terrific job of showing how to think through this. Just think in simple terms: S1, beginning of systole, is the CLOSURE of the tricuspid and mitral valves. S2 is the CLOSURE of the aortic and pulmonic valves. Regurgitation is a problem with valves closing, and the tricuspid/mitral valves are closed in systole, so regurg of either valve must be a systolic murmur. Stenosis is a problem with valves opening, right? What's open in systole? Aortic and pulmonic -- which means AS and PS are systolic murmurs. And the tricuspid / mitral are open in diastole, so stenosis of either valve is a diastolic murmur.

AS/MS are both left-sided in terms of anatomy, but there's the rIght / lEft thing to remember what's louder when.

 

[blueboyscholar]

Step1Hash, that is excellent advice (I actually wrote the part about systolic length in my FA)! One other thing, and I hate to ask, but I thought you auscultated for MS at the apex. Are you saying that, as a secondary location, it can be heard at the axilla?
And exi, I can't remember what "the rIght / lEft thing" is, but it sounds important. Can you please jog my memory?

 

[Step1Hash]

That is excellent advice (I actually wrote the part about systolic length in my FA)! One other thing, and I hate to ask, but I thought you auscultated for MS at the apex. Are you saying that, as a secondary location, it can be heard at the axilla?

sorry you hear it at the apex at the 5th midclavicular line and it radiates to the axilla. Whenever I hear mitral I think axilla automatically almost as a buzz word so I think thats why I typed that.

 

[da8s0859q]

And exi, I can't remember what "the rIght / lEft thing" is, but it sounds important. Can you please jog my memory?

Sure thing: right-sided murmurs are louder on inspiration; left-sided murmurs are louder on expiration. Just an easy way to remember what's easier to hear when.

sorry you hear it at the apex at the 5th midclavicular line and it radiates to the axilla. Whenever I hear mitral I think axilla automatically almost as a buzz word so I think thats why I typed that.

I think you're thinking of mitral regurg... radiates to the axilla.

 

[Step1Hash]

Sure thing: right-sided murmurs are louder on inspiration; left-sided murmurs are louder on expiration. Just an easy way to remember what's easier to hear when.



I think you're thinking of mitral regurg... radiates to the axilla.

yep, my bad again.

 

[fenceguy1984]

Ao sten - systolic
Mitral sten - diastolic

If you have to ID it from an audio clip, just figure out if its lub or dub.
lub-dub . . . . systolic is shorter (lub) and the other, well, thats the other . . .