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Mid-systolic ejection Dilation of aortic root or pulmonary artery Produces an ejection sound, with a short ejection systolic murmur and a relatively wide split S2. There is no hemodynamic abnormality. This is similar to pulmonary hypertension except the latter has hemodynamic instabilities. Mid-systolic ejection Increased semilunar blood flow
Pulmonary valve stenosis is a crescendo-decrescendo systolic murmur. One can hear it best at the left upper sternal border. It has association with a systolic ejection click that increases with inspiration. This finding results from an increased venous return to the right side of the heart. Pulmonary stenosis sometimes radiates to the left ...
Location DDx; Still's murmur [4] inferior aspect of LLSB (lower left sternal border), systolic ejection sound, vibratory/musical quality subaortic stenosis, small VSD: Pulmonary ejection superior aspect of LLSB, ejection sound Pulmonary stenosis, atrial septal defect: Venous hum
The grading gives a number to the intensity from 1 to 6: [2] [3] The palpable murmur is known as thrill, which can be felt on grade 4 or higher. The murmur is only audible on listening carefully for some time. The murmur is faint but immediately audible on placing the stethoscope on the chest. A loud murmur readily audible but with no thrill. [4]
The first heart sound, or S 1, forms the "lub" of "lub-dub" and is composed of components M 1 (mitral valve closure) and T 1 (tricuspid valve closure). Normally M 1 precedes T 1 slightly. It is caused by the closure of the atrioventricular valves , i.e. tricuspid and mitral (bicuspid), at the beginning of ventricular contraction, or systole .
Auscultatory findings include inspiratory third heart sound at left lower sternal border (LLSB) [16] and a blowing holosystolic murmur at LLSB, intensifying with inspiration, and decreasing with expiration and Valsalva maneuver. [16] Patients may have a parasternal heave along LLSB. [16]
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The diagnosis of pulmonary valve stenosis can be made using stethoscopic auscultation of the heart, which can reveal a systolic ejection murmur that is best heard at the second left intercostal space. [9] Transthoracic or transesophageal echocardiography can provide a more accurate diagnosis.
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