CVS examination Pearls

VSD Large vs VSD Small

pericardial bulge    | no bulge
blowing character  |   harsh character
no thrill                  | thrill may be there
Lt ParaSternalHeave| no heave
Loud P2                 | S2 normal
2/6 intensity           |  Grade IV murmur(with thrill)
FTT                        | 


With all murmurs the associated heart sound is of soft or absent,
except that with MS it is LOUD S1
And so,
with MR it is soft S1,
AR soft S2
AS soft S2
PS soft S2
PR soft P2

but since PR may be associated with pulmonary hypertension, so there may be Loud P2.

And Oh, all murmurs have HIGH pitch except MS murmur which has low pitch .


ASD fixed splitting of S2
AS reverSe splitting


Pink TOF behaves like VSD., (same pneumonias?, and examiantion findings)

AR when to operate:
symptoms of Angina
symptoms of Exertional dyspnea
Falling EF

When to Operate in MR:
EF < 60%
FTT
Pul HTN
CCF refractory to medical treatment