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Clinical signs of valvular heart diseases and septum defects and congenital heart diseases

PALPATION AUSCULTATION

APEX CHARACTER OF
CONDITION
PARASTERNAL PULMO AORTIC MITRAL TRICUSPID AORTIC PULMO PULSE
DISPLACED CHARACTER

Palpable P2 since there is pulmonary Mid-diastolic, best heard on left lateral PSM can be present in late cases due to Loud P2 due to pulmonary hypertension -
Mitral stenosis Localized Tapping Left parasternal heave Character is not the rate
hypertension position on expiration TR Graham steel(pulmonary hypertension)

Pan systolic conducted to axiila, best

Displaced downward and Palpable P2 since there is pulmonary PSM is heard as radiates from mitral area Rapid upstroke with a
Mitral regurgitation Hyper dynamic Left parasternal heave heard in mitral area and enhanced by Loud P2 due to pulmonary hypertension
outwards hypertension - short duration
expiration

Non-displaced wrong-Displaced ( Slow rising pulse,

Ejection systolic murmur radiates from Ejection systolic , conducted to clavicle Ejection systolic murmur radiate from
Aortic stenosis down and out) due to LVH Heaving Systolic thrill nd Delayed upstroke (Parvus
aortic valve and carotid / soft 2 sound aortic area
[presure overload]- et bardus)

Displaced outward due to LVH 3rd heart sound in severe cases because decrecendo early diastolic murmur
Aortic regurgitation Hyperdynamic Palpable diastolic thrill collapsing pulse
(volume overload) of dilated left ventricle accentuated

Displaced (out) due to LVH Thrusting or Blowing pansystolic murmur does not
Tricuspid regurgitation Left parasternal heave no special character
(volume overload) hemodynamic radiate to axilla and to the right side

Harsh pansystolic murmur radiate to

Ventricular septal defect displaced laterally dynamic left parasternal heave palpable p2 Loud P2 due to pulmonary hypertension no special character
right side but left axilla in small vsd

laterally displaced because of Ejection systolic, loud and fixed slit 2nd
Atrial Septal Defect normal/thrusting left ventricular heave palpable p2 functional mid-diastolic murmur ESM radiates from pulmonary area
RVH laterally heart sound

laterally displaced because of harsh mid-diastolic murmur radiate to left

Pulmonary stenosis normal/thrusting left ventricular heave systolic thrill ESM radiates from aortic area normal
RVH laterally side of neck, soft 2nd sound

laterally displaced because of

Fallot tetralogy normal/thrusting right ventricular heave systolic thrill Systolic ejection murmur, soft 2nd sound normal
RVH laterally

Eisenmenger's syndrome laterally displaced because of RVH laterally right ventricular heave soft murmur/no murmur soft murmur/no murmur systolic ejection murmur, loud p2 normal

prosthetic click louder in 1st heart

Mitral prosthetic valve palpable prosthetic click palpable prosthetic click prosthetic click louder in 1st heart sound prosthetic click louder in 1st heart sound prosthetic click louder in 1st heart sound normal
sound

prosthetic click louder in 2nd heart prosthetic click louder in 2nd heart prosthetic click louder in 2nd heart prosthetic click louder in 2nd heart sound
Aortic prosthetic valve palpable prosthetic click prosthetic click louder in 2nd heart sound normal
sound sound sound with ejection systolic murmur