[Heart Sounds & Murmurs] | | | Liver & Ascites | | | Neck Veins | | | Pulmonary | | | Thyroid |
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Teaching Tips: Heart Sounds & MurmursGeneral Points
Heart Sounds & MurmursAlgorithm for using maneuvers and dynamic auscultation to diagnose a confusing systolic murmur: Murmur Analysis with Dynamic Auscultation
You can also distinguish between AS and MR by changes in intensity after changes in cycle length. Listen for a beat after a PVC. With a longer time between beats, there is increased filling, increased contractility and decreased afterload. This increases the flow across the aortic valve leading to an increase in AS murmur intensity. It decreases the regurgitant flow across the mitral valve as more blood flows forward with the decrease in afterload, decreasing the intensity of the MR murmur. Teaching Tip: It is easier to hear the different intensities of the normal beat and post PVC murmur by listening to the post PVC murmur and then the murmur associated with the subsequent normal beat. This is easier to hear than remembering the intensity of the murmur that occurred before the pause and comparing it to the post extra beat murmur. Engage Learners During Exam
Case ExampleExample of evidence-based teaching case (aortic stenosis)(Case adapted from presentation by Paul Sutton, MD, PhD.) Friction RubsThe traditional descriptions of friction rub used correlations such as "leather rubbing together" (examples such as a saddle and leather pants). Now these are irrelevant since most of us don't even know what leather sounds like! Better examples to convey the sound are:
The teacher can ask students and residents some of the following questions. Which may help them to understand pericardial rubs better: Question 1: What are the timing of sounds in a pericardial rub? |
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