MD Cheatsheet

Heart Sound & Murmur

Auscultation Location

S1 S2 – Normal S3 sudden deceleration in S4 atrial contraction to

Physiological Split when left ventricular flow and eject blood to stiff/High
inspiration tensing chorda tendinae Pressure LV
Loud S1 Wide Split
 Mitral/Tricuspid  RBBB  Hyperkinetic  Hypertension
Stenosis or  PS Heart  AS
Thickening  PE (Thyrotoxicosis,  Coartaction Aorta
 Hyperkinetic Anemia,
 CPC
heart (Anemia, Pregnancy) Non exist in AF
Thyroid heart  Increase Preload
Fixed Split
(VSD, AR, MR,
disease)  ASD
PDA)
 VSD
 CHF
 RV Failure
Variable S1 Paradoxical Split
 AF  LBBB
 VT  AS
 AV Block  TR
 Pulsus Alternans  RA Myxoma
Soft S1 Single
 LBBB  Emphysema
 Calcified  AS
Mitral/Tricuspid  PS
 LV Failure
 MR or AR
Systolic Extra Heart Sound Diastolic Extra Heart Sound
 Valvular AS  Opening Snap -Loud short snapping early
 Bicuspid Aortic diastolic sound produced by sudden tensing and
 PH deceleration blood flow thru stenotic (but Still
mobile) AV Valve, predominantly anterior leaflet.
 MVP
Earlier OS, The Worse stenosis – RHD, MS
 Prostetic Valve  Gallop – CHF, HCM
 Pericardial Friction Rub  Tumor Plop - Myxoma
 Pericardial Knock – Restrictive
Cardiomyopathy
MS MR AS AR
S1 Loud Holosystolic Murmur in Systolic ejection murmur Diastolic murmur LSB
Diastolic Rumble in apex apex radiating to axilla radiated to neck while upward and
Disertai Opening Snap Systolic apical thrill Weakened Carotid leaning patient
P2 mengeras bila ada PH Displaced apex to left upstrokes Corrigan Pulse
S3 heard Pulsus parvus et tardus Durozies Sign
Forceful apical beats Bobbing Head/ de
Intensed murmur with Soft or lost A2 musset
handgrip, squat, leg raise component Austin Flint Murmurdue to
vibration of the mitral valve
S4 caused by the impinging AR is a
Increased murmur with low-pitched diastolic rumble heard
toward the LV apex
Squat, nitrat, leg raise

MVP HCM PS PR
Mid-systolic click Harsh cresendo-
The clicks are believed to result
from the sudden tensing
decrescendo systolic
of the mitral valve apparatus as murmur
the leaflets prolapse into the left
atrium during systole. intensed with Valsava
Late systolic murmur and Amyryl Nitrate
ASD TR PDA VSD

Murmur intensed with

handgrip, squat, leg raise