Summary Essential Notes: Cardiology: Murmurs & ECGs

Murmurs & ECG
interpretation
Murmurs
Distinguishing Extra
What do you hear? Murmur Where? What is it?
features features

HS I + II Everywhere Nil Nil Normal


Pansystolic Apex Radiates to axilla + AF? Mitral regurgitation

PSM
Tricuspid
Pansystolic Tricuspid area Loudest on inspiration Giant V wave in JVP
regurgitation
Pulsatile liver

Ejection Systolic Narrow pulse
Aortic region Radiates to carotids Aortic stenosis
(Cres-decres) pressure


Wide pulse
Early Diastolic Left sternal edge Loudest sitting forward pressure Aortic regurgitation
Collapsing pulse


Mid-diastolic Long angry
Mitral area Loudest w/ bell Mitral stenosis
rumbling murmur




Pansystolic As for murmurs Mixed murmur- mitral
Apex + LSE As for murmurs above
murmur + EDM above + aortic regurgitation

1st 2nd 1st


S1 Mitral + Tricuspid valves shut  Ventricles contract S2 Aortic + Pulmonary valves shut  Ventricles relax
1. Mitral regurgitation 1. Aortic regurgitation
2. Tricuspid regurgitation 2. Pulmonary regurgitation
3. Aortic stenosis 3. Mitral stenosis
4. Pulmonary stenosis 4. Tricuspid stenosis




ECG
ECG
Ab
Abn
ECG interpretation
1. Confirm patient name + DOB
2. Confirm date + time ECG was performed
3. Rate = 300/ no. of large squares between R-R interval QRS complex 1st
1 =300 bpm, 2= 150bpm, 3= 100bpm, 4=75bpm, 5=60bpm, 6=50bpm
4. Rhythm
P waves present? Yes  Sinus; No  AF tach
P waves precede QRS complex?
Atrial flutter = saw-tooth baseline
5. Axis
Leads I + II Positive = Normal T wave
Lead I Positive + Lead II Negative = ‘Leaving’ Left-axis deviation P wave 2nd
Lead I Negative + Lead II Positive = ‘Reaching’ Right-axis deviation ST segment
M
6. Segments I/W
P waves PR interval QRS complex ST segment PR
QT interval
interval QT interval
T waves
Absent AF/SAN Atri
Toxins (macrolides,
block Wide conduction defect/ Elevated
anti-arrhythmias, Peaked: hyper-
Dissociated WPW Acute MI
TCAs, H2 K+
Complete HB Long HB Pathological Q wave > Pericarditis: saddle-
antagonists) Flattened: hypo-
P-mitrale (bifid) Short accessory 1mm wide +>2mm shaped
Inherited K+
LA hypertrophy, conduction e.g. depth Ventricular
Myocarditis Normal aVR + Mo
HTN, AS, MR, MS WPW Full thickness MI aneurysm
Mitral valve V1
P-pulmonale Depressed RVH dominant R wave Depressed
prolapse V2 +V3 (Afro)
(peaked) RA pericarditis (V1) + deep S wave (V6) Ischaemia: flat
Electrolytes: low Abnormal I, II,
hypertrophy, LVH R wave (V5/V6) + S Digoxin: sloping
Mg2+, K+, Ca2+, V4-V6
pulmonary HTN, wave (V1) down/reverse tick
temp (J waves) fib
COPD