Murmur Madness: The Audio PANCE and PANRE Episode 45

Welcome to episode 45 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast. Today we are going to take a brief detour away from 10 daily questions and instead cover the murmurs you need to know for your PANCE and PANRE exam. I have still included an 11 question exam at the end of this post so make sure you scroll down after you listen to the podcast. There are a total of 17 cardiac conditions that may present on exam day in the form of a descriptive sound/murmur. You will often be given supporting evidence such as the location of auscultation or radiation which you can use to narrow down your options. There are total of 51 cardiac topics in the  NCCPA™ Cardiology PANCE and PANRE Content Blueprint which represents 16% of the PANCE and PANRE exam. (click here to download the FREE NCCPA Content Blueprint cheat sheet) These cardiac conditions and their associated murmurs cover a whopping 33% of the cardiology section of the PANCE and PANRE exam! Take a listen to this week's podcast episode If you can't see the audio player click here to listen to the full episode. Let's break this all down: Each of the links below opens the corresponding lesson on SmartyPANCE and is available to members (you must be logged in or join now) There are 9 valvular disorders associated with murmurs: Valvular Disorders (PEARLS and Flashcards) Aortic stenosis (ReelDx) Aortic regurgitation (Diastolic Murmur) Mitral stenosis (Diastolic) Mitral regurgitation Mitral valve prolapse Tricuspid stenosis Tricuspid regurgitation Pulmonary stenosis Pulmonary regurgitation Five congenital heart diseases that have corresponding murmurs Congenital Heart Diseases (PEARLS) Atrial septal defect Coarctation of the aorta Patent ductus arteriosus Tetralogy of Fallot Ventricular septal defect One murmur associated with cardiomyopathy Hypertrophic cardiomyopathy And a pair of conditions nested under the label of "other forms of heart disease" that have associated murmurs/heart sounds worth mentioning Other Forms of Heart Disease (PEARLS) Acute and subacute bacterial endocarditis Acute pericarditis Making Sense of Murmurs Let's start with the valvular disorders: You have 4 heart valves with two main conditions - half are diastolic murmurs and half are systolic murmurs. Here is a helpful mnemonic: Recalling Common Systolic Heart Murmurs: MR PASS M itral R egurgitation P hysiologic (also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality) A ortic S tenosis S ystolic - All the above murmurs are heard during systole. MR PASS wins the Most Valuable Player award. M itral V alve P rolapse - Add MVP as another systolic murmur. MR PASS often hangs around with MS ARD. M itral S tenosis A ortic R egurgitation D iastolic - All the above murmurs are heard during diastole. Here are the nine valvular murmurs and their associated descriptions Remember which are systolic and diastolic this can be very helpful at ruling out or ruling in a condition come exam day. Aortic Stenosis - Systolic harsh ejection crescendo decrescendo murmur at RUSB (aortic area) with radiation to the neck and apex Aortic Regurgitation - diastolic - soft high pitched blowing at LSB with patient sitting leaning forward and exhaling Mitral stenosis - diastolic - low pitched decrescendo rumbling with opening snap at the APEX (the mitral area) enhanced by expiration Mitral regurgitation - blowing holosystolic murmur loudest at the APEX (the mitral area) with a split S2 that radiates to the axilla and is increased by squatting, handgrip and expiration Tricuspid Stenosis - diastolic - mid diastolic rumbling at LLSB (tricuspid area) with opening snap Tricuspid regurgitation - High pitched holosystolic blowing murmur that radiates to the LSB (tricuspid area) ...