cardiology | Master Of Medicine

Category Archives: cardiology

Heart murmurs and their physiologic responses to stress

Heart murmurs vary in quality and duration with specific physiological influences.Knowing these changes can help us differentiate between specific murmurs.



Right sided heart murmurs become loud with inspiration

  • Systolic sounds – TR/PS
  • Diastolic sounds – TS/PR
  • Right sided s3 and s4 also become louder


  • Left sided heart murmurs become loud with expiration.
  • Pulmonic ejection sound also becomes louder.

Valsalva manuever

  • Most murmurs decrease in length and intensity with valsalva.
  • Two exceptions are HCM and MVP.


Postional changes


  • Most murmurs decrease in intensity
  • Exceptions are HCM and MVP


  • Most murmurs become more intense with squatting
  • Exceptions are HCM and MVP which become softer.

Passive legraising

  • All murmurs except HCM and MVP increase in intensity


  • Murmurs due to blood flow across normal or stenotic valves(PS and MS) become louder with isotonic and Isometric (handgrip)exercise.
  • MR,VSD and AR also increase with handgrip.
  • Leftsided S3 and S4 gets accentuated
  • HCM decrease with near maximum handgrip.


Clinical features of Infective endocarditis

Clinical features of Infective endocarditis is one of the favorite questions of examiners. Given below is the clinical features of IE and short explanations.

  1. Oslers nodes- tender nodules in pulp of fingers and sole.
  2. Janeway lesions – Non tender erythematous macules in palms and sole.
  3. Mycotic aneurisms- focal dilatations in arteries due to weakening by infection.
  4. Micro abscesses, hemorrhagic stroke.
  5. Roth’s spots, Glomerulonephritis.
  6. Perivalvular abscesses, MC around aortic valve.
  7. MC cause of death: Heart Failure due to valvular insufficiency.

Named heart murmurs and their causes

  1. Carey Coombs murmur- Mid diastolic murmur, in rheumatic fever
  2. Austin Flint murmur- mid- late diastolic murmur,in  Aortic Regurgitation.
  3. Graham- Steel murmur- high pitched, diastolic, in pulmonary regurgitation.
  4. Rytands murmur - mid diastolic atypical murmur, in Complete heart block.
  5. Docks murmur-diastolic murmur, Left Anterior Descending(LAD) artery stenosis.
  6. Mill wheel murmur- due to air in RV cavity following cardiac catheterization.
  7. Stills murmur- inferior aspect of  lower left sternal border, systolic ejection sound, vibratory/musical quality,in subaortic stenosis, small VSD

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