Cardiac help... pretty please?

chare · Jul 2, 2009

the ausculation assistant - systolic murmurs

hope this helps! :specs:

Daytonite, BSN, RN · Jul 2, 2009

just to be clear here. . .asd. . .atrial septal defect, correct? there are several types of murmurs that the patient can have (from page 100, nurse's 5-minute clinical consult: diseases):

early to midsystolic murmur at the 2nd or 3rd left intercostal space
low-pitched diastolic murmur at the left lower sternal border which is more pronounced on inspiration
late systolic murmur at the apex

you might want to read this article on emedicine: http://emedicine.medscape.com/article/889394-overview. there were about 5 articles on emedicine about asc, but this one is about the general concepts of asd. the only murmur it mentions is in relation to mitral valve prolapse and it is an apical holosystolic or late systolic murmur which is the 3rd one listed on the list above. the article also mentions systolic ejection murmur in the pulmonic area when there is right ventricular hypertrophy.

your question is interesting to me, so i am looking at what differential diagnosis in primary care, 4th edition, by r. douglas collins has to say about murmurs because taber's doesn't say a lot. this is a textbook for medical students. on page 308 it says this:

"the first consideration on hearing a heart murmur is to determine whether the murmur is functional [usage-having to do with the working of the heart] or organic [structural--having to do with the physical construction of heart]. certainly, the low-grade systolic murmurs tend to be functional; if the murmur changes or disappears on position, inspiration or exercise it is likely to be functional.

a diastolic murmur, however, is invariably organic.

perhaps the most significant question to ask is, "are the heart sounds normal?" this is a decisive factor in many cases. if the heart sounds are normal, organic disease is unlikely."

based on that information, since asd is an organic disease of the heart where the atrial septum is messed up anatomically, i would say that the answer to your question would be any diastolic murmur. that certainly makes the most sense. the other systolic murmurs would all fall into the category of being functional murmurs.

http://www.fpnotebook.com/cv/exam/dstlcmrmr.htm - diastolic murmur
http://www.cvphysiology.com/heart%20disease/hd008.htm - systolic and diastolic murmurs (read very carefully as it is talking about ventricular septal defect, not atrial)

Student4Now · Jul 3, 2009

Thanks to both you- definitely a lot of info there that I couldn't find before! By digging into this a little, I see a lot of mixed info as well. I am noticing that it could be midsystolic or mid-diastolic. However Daytonite, you make a great case, because if the disease is organic, then the typical murmur should be diastolic. I think that a systolic murmur in a child with ASD is indicative of mitral valve prolapse in most cases. Although mitral valve prolapse is common they did only ask about ASD, so I think I should go with diastolic on this one. Thanks so very much to you both. I am gonna bookmark those links as well to get me through this cardio module. :bugeyes:

allnurses Guide · Jul 3, 2009

You'll get a fixed split S2 (not varying during inspiration) and a systolic ejection murmur due to increased flow through the pulmonic valve after L->R flow via ASD if I recall correctly.

Student4Now · Jul 3, 2009

I am thoroughly confused! :thnkg: lol