Clear and Crisp. Watch it and go through your notes. 8yrs and I'll still recommend this because there's no other video that explains murmurs this clearly.
In a patient with AS, the % increase in gradient from 50ms after systole onset to mid systole at 150ms might be 300%. While in MR, this % increase might be closer to 50%. On a phonocardiogram (a visual representation of the sound waves causing murmurs), the crescendo-decrescendo nature of an MR murmur can sometimes be noted, but the steep crescendo segment at the beginning of systole, and decrescendo segment at the end are so brief that our ears can't perceive it, and thus it sounds uniform.
The atrial kick is not the same as the opening snap. The atrial kick is the extra push of blood through the mitral valve as a consequence of atrial contraction, which occurs at the end of diastole. The opening snap is the sound of a mitral valve opening at the very beginning of diastole. My video, "Examples of mitral stenosis murmurs" contains a good opening snap/MS example with both an audio clip, and a picture of the sound waves. Hope that helps!
holy crap i learnt more from this video than all the heart sounds and murmur lectures I had in school. and after i was done watching i realised that its a 10 year old video?? this is amazing! no wonder my professors think your videos are the best
No one has really bothered to explain how the shape of murmur is linked to the pressure gradient. Good job on that, Dr Eric! Your videos are truly eye openers ! Thank you so much
PA student here. Thank you for putting all the concepts together and building them up into the examples. We were given all of these pieces separately and seeing how the pressure difference in structures produced the murmur finally made sense of it to me.
NP student about to start clinical rotations. I wanted to brush up on my Cardiac skills and your videos are excellent! Easy to follow and plenty of examples. Thank you.
Thank you so much for the concise review of heart murmurs!! I'm a third year med student in Australia and have just commenced my cardio rotation; this video has been a life-saver in helping me review the basics -much appreciated!
it's an awesome lecture. I struggled to learn heart murmur when I was a medical student, and I have been confused up until now when auscultating the heart. Now I get it. I tried to memorize when I was a student, now I understand the murmur. Thanks a lot!!
Thanks a lot! I´ve seen already some of your videos and find them excellent. The physiological explanations are, hands down, one of the best ones I´ve ever seen. Please keep posting more interesting videos. Thanks again!
Very good review, Dr. Strong. Sometimes it's worthwhile to glance at adult cardiology in order to rediscover what --and what doesn't-- resonate in children. Preparing to maintain certification in pediatrics. Very helpful. Thank you.
As an older clinical cardiologist I applaud your very timely, expert and excellent lecture. Well done and much needed. I hate the reflex: "systolic murmur, lets get an echo!"
I stumbled upon this earlier today, studying for my usmle and I find these lectures to be informative and easy to understand. Thank you so much for taking your time to make these for the general public. They are incredibly helpful. I've always had a hard time with heart sounds.
Bit of a fudge? Yes and no. The pressure gradient for MR does technically have a "crescendo-decrescendo" shape. However, due to the very rapid rise in LV pressure while LA pressure is minimally changed, and rapid drop off at the end of systole, the gradient is more a crescendo-plateau-decrescendo shape (at least more so than in AS). For example, imagine if the HR is ~80 bpm, and systole lasts 300ms.
I'm not a medical student, I'm a patient who underwent mitral valve repair and aortic valve replacement surgery. I just think this stuff is really interesting to learn!
It's an example of how murmurs don't localize very reliably to a specific place on the chest wall. While aortic murmurs are most often best heart in the right 2nd intercostal space, in an individual patient they can be best head just about anywhere in the chest. The "tricuspid area" is actually a common place for aortic regurg murmurs.
thank u so much sir for your videos. These are the assets for medical students and new doctors like me. Massive respect from the core of my heart.May Allah bless u sir.
обожаю кардиологию и Генделя и ещё у Эрика приятный тембр и манера подачи! его лекции помогают мне обучать студентов, за что огромная благодарность! принтскриню конешно))
Lung sounds is on the short list of topics to get to soon. I'm just waiting to come across some better (i.e. more classic) examples of pathology to record and use for the video.
Thanks for explaining - makes more sense now. In AS the aortic and LV pressures follow each other more closely, so any difference takes longer to evolve, hence the more obvious crescendo-decrescendo. A subtlety though, as you say, and unlikely to come up in med school exams :) Keep up the great videos!
I've got 2 more days of heavy clinical responsibilities, then a long break of 100% teaching and admin, which will hopefully give me enough time between now and the end of the calander year to cover hypo and hypernatremia, hypo and hyperkalemia, coagulation disorders, lung sounds, surface tension, and if I'm lucky, hypertension. Will need to reassess where I'm at after Jan 1, but there had been a lot of prior requests for clinical biochem, so I may tackle that then.
Thanks a lot for a great video! I'm a medicine student from the University of Buenos Aires, in Argentina. Last week we had an 60 y/o patient with mitral stenosis due to rheumatic fever as it's still somewhat common to see here in public hospitals. anyways,thanks again!
I HAD TROUBLE TO UNDERSTAND THE TIMING ,SHAPE,AND THE PITCH OF THE MURNURS NOW ON WITH THIS LECTURE I'M TOTALLY CLEAR , I WANT TO THANK YOU FOR YOUR TIME AND YOUR DEDICATION. THANKS!
Thank you Dr Strong. I nearly wanted to skip these 2 murmur thing lecture of you. I am so aversive of it. I anyhow think this is the great lecture. I am glad that i did
brilliant and awesome crescendo and decrescendo of the decrescendo in murmur's art , continous and the best all over the pericordium. many thanks in deed...........
I watched this video, for the first time, the summer before starting medical school. I had absolutely no idea how I was going to digest all of that information. Watched it again, today, as a second year medical student, and I was able to easily identify all of the Pathology within a few seconds of hearing the murmurs! Great video, and it was also very encouraging to rewatch. My concern is, as a military vet, I've lost a good portion of my hearing (especially at high frequency). Is there any clinical tools that you recommend for amplifying the sounds (other than increasing preload)?
Interesting question if you don't mind: have you ever seen anticoags to decrease viscosity significantly enough to produce murmurs in some patients? I only ask because they are somewhat common among the older patients who we would be looking for murmurs in most often...
That's a great question! Conventional wisdom among doctors is that anticoagulants don't impact blood viscosity, and thus shouldn't impact the presence of murmurs. However, I wasn't sure where this conventional wisdom came from, so just did a brief literature search. As far as I can find, anticoagulants (e.g. heparin) do appear to decrease whole blood viscosity (conventional wisdom may be wrong...), though the studies I found were all very small, in relatively obscure journals, and most were relatively old (i.e. 1960s-1970s). I also couldn't find any trials discussing antiplatelet drugs (e.g. aspirin, Plavix) or even coumadin. I will say that anecdotally, in my own experience, I haven't personally observed an increased incidence of flow murmurs among patients on anticoagulation, or heard a flow murmur develop when starting a heparin infusion which then goes away when the heparin is stopped. I think it's certainly a plausible effect, but strongly suspect that even if it occurs, the effect size is quantitatively small enough as to not significantly impact an individual's diagnostic reasoning process when encountering a patient on anticoagulation who has a murmur. (i.e. I would not attribute a murmur to the use of a "blood thinner")
Dr. Eric I just logged in to comment here.. this very lecture helped me learning such great deal that hours of cardiology lecture in my med school did not! Awesome! Now i would like to put up an old request of mine.. Please please make a video on CT Brain. Thanks.
Megh o Roddur I think I remember this request from before! I sincerely do appreciate viewer requests and plan on honoring as many as possible. Unfortunately, I'm literally 200 topics behind at this point. For a while now, I've been focusing on topics which also either have strong relevance to the current curriculum here at Stanford, and/or topics which I know particularly well (because I can complete them a little bit faster). Head CTs don't fall into either category, so for now, it's on my extended list of topics to cover (in contrast to the "short" list). It's definitely a good suggestion though, and I will try my best to get to it - just can't predict when.
Excellent video, very interesting. Just one point - on describing the pressure gradient responsible for the pansystolic murmur of mitral regurgitation. Bit of a fudge? The pressure gradient is clearly crescendo-decrescendo if you subtract the LV pressure from the LA pressure; even more so than the LV / aorta pressure gradient that gives you the classic ejection crescendo-decrescendo murmur.
On the 3rd example, can you mention why the patient's height and exercise intolerance are relevant? It suggests Marfan syndrome to me, but would be satisfying to hear your take on it.
Yes, the height was a very subtle suggestion of possible Marfan's syndrome, which is associated with aortic root dilatation and aortic regurgitation (I can't believe I didn't mention that in the video!) The exercise intolerance was meant to be more indicative of chronic aortic regurg in general rather than Marfan specifically.
I will admit that the diagram in the lecture that shows the MR gradient intentionally underemphasizes it's crescendo-decrescendo nature, which I did to prevent confusion on a subtle point. Nice catch though. Hope that helps to clarify.
Hi. very good lecture. I want just to get some clarity on the 5th example. You said that it was a case of aortic stenosis and regurgitation. Can a valve that is stenotic regurgitate? I thought that if there is stenosis, the hole is small and blood may not regurgitate backward. Can it be a case of aortic stenosis superimposed to mitral regurgitation?
Clear and Crisp. Watch it and go through your notes. 8yrs and I'll still recommend this because there's no other video that explains murmurs this clearly.
The best illustration I have ever watched about murmurs. I am really thankful.
Aortic stenosis 10:21
Aortic regurgitation 10:41
mitral regurgitation 11:43
Mitral stenosis 12:20
quizzes start at 19:05
This is by far, one of the best heart murmur tutorials on youtube. Thanks!
This is the BEST, most useful, clearest and most practical lecture on heart sounds, in my experience. Thank you soooo much for sharing.
In a patient with AS, the % increase in gradient from 50ms after systole onset to mid systole at 150ms might be 300%. While in MR, this % increase might be closer to 50%. On a phonocardiogram (a visual representation of the sound waves causing murmurs), the crescendo-decrescendo nature of an MR murmur can sometimes be noted, but the steep crescendo segment at the beginning of systole, and decrescendo segment at the end are so brief that our ears can't perceive it, and thus it sounds uniform.
The atrial kick is not the same as the opening snap. The atrial kick is the extra push of blood through the mitral valve as a consequence of atrial contraction, which occurs at the end of diastole. The opening snap is the sound of a mitral valve opening at the very beginning of diastole. My video, "Examples of mitral stenosis murmurs" contains a good opening snap/MS example with both an audio clip, and a picture of the sound waves. Hope that helps!
holy crap i learnt more from this video than all the heart sounds and murmur lectures I had in school. and after i was done watching i realised that its a 10 year old video?? this is amazing! no wonder my professors think your videos are the best
best one..
this person has really has a knack for teaching
This is absolutely the best video on this topic on youtube. God, it made everything so clear
Thanks!
Wow! Thank you so much sir. I am a MS4 US MD going into Family Medicine. Thank you for these videos and helping me brush up on my skills. THANK YOU.
No one has really bothered to explain how the shape of murmur is linked to the pressure gradient. Good job on that, Dr Eric! Your videos are truly eye openers ! Thank you so much
This is the best video I've seen about heart murmurs. The audio clips are very helpful!!
PA student here. Thank you for putting all the concepts together and building them up into the examples. We were given all of these pieces separately and seeing how the pressure difference in structures produced the murmur finally made sense of it to me.
Simple, clear, and short video describing both systolic and diastolic murmurs
.
NP student about to start clinical rotations. I wanted to brush up on my Cardiac skills and your videos are excellent! Easy to follow and plenty of examples. Thank you.
Thank you so much for the concise review of heart murmurs!! I'm a third year med student in Australia and have just commenced my cardio rotation; this video has been a life-saver in helping me review the basics -much appreciated!
Ver Nice~
+Armando Hasudungan Thanks! I love your channel, and have referred numerous people to it.
two great legends!!!nice
3rd year med student from India. I love your videos and they're really helpful. Thanks a lot!
+Vishnu S Cool same here, which college?
it's an awesome lecture. I struggled to learn heart murmur when I was a medical student, and I have been confused up until now when auscultating the heart. Now I get it. I tried to memorize when I was a student, now I understand the murmur. Thanks a lot!!
One of the best lectures on heart sounds and murmurs!! Thank youuuu!!
Thanks a lot! I´ve seen already some of your videos and find them excellent. The physiological explanations are, hands down, one of the best ones I´ve ever seen. Please keep posting more interesting videos. Thanks again!
Thank you so much. I am an NP student and this information was extremely helpful as a review. It was by far the best review on murmurs!
Dr. Strong! This is fantastic! Thank you for making this available on the web!
One of the best murmur lecture I've seen. Thank you so much!
Very good review, Dr. Strong. Sometimes it's worthwhile to glance at adult cardiology in order to rediscover what --and what doesn't-- resonate in children. Preparing to maintain certification in pediatrics. Very helpful. Thank you.
As an older clinical cardiologist I applaud your very timely, expert and excellent lecture. Well done and much needed. I hate the reflex: "systolic murmur, lets get an echo!"
This was an exceptional Murmur tutorial better than anything Kaplan has put out ! Thank you so much Doctor!!!
You are a hero dear Professor!
Laura, I'm glad you found them helpful. The music is Handel's Suite No. 1 in F major, Hornpipe.
I stumbled upon this earlier today, studying for my usmle and I find these lectures to be informative and easy to understand. Thank you so much for taking your time to make these for the general public. They are incredibly helpful. I've always had a hard time with heart sounds.
GREAT. VERY VERY INFORMATIVE. EXCELLENT NARRATION. SIMPLICITY AT ITS BEST.
The best murmurs tutorial-clear and concise.
Thank you very much for the lecture! I'm a medical student from brazil, this helped me a lot!
Bit of a fudge? Yes and no. The pressure gradient for MR does technically have a "crescendo-decrescendo" shape. However, due to the very rapid rise in LV pressure while LA pressure is minimally changed, and rapid drop off at the end of systole, the gradient is more a crescendo-plateau-decrescendo shape (at least more so than in AS). For example, imagine if the HR is ~80 bpm, and systole lasts 300ms.
thank you for the thorough yet simplified explanation of murmurs. cheers
Best lecture on heart murmurs i have ever watched
What a resource, and for free? Thank you so much, such a thoughtful act my friend!!
very good lecture helped a lot to understand murmurs of heart
I'm not a medical student, I'm a patient who underwent mitral valve repair and aortic valve replacement surgery. I just think this stuff is really interesting to learn!
It's an example of how murmurs don't localize very reliably to a specific place on the chest wall. While aortic murmurs are most often best heart in the right 2nd intercostal space, in an individual patient they can be best head just about anywhere in the chest. The "tricuspid area" is actually a common place for aortic regurg murmurs.
Thank you so much this makes more sense to me as a medical student.
very useful, I finally understood the differences, loud and clear..
thank u so much sir for your videos. These are the assets for medical students and new doctors like me. Massive respect from the core of my heart.May Allah bless u sir.
Best video lecture on the topic. Great doctor teacher. Happy doctor's day sir !( 1july22)
this clip is fantastic, thanks a lot Eric. I wish lectures here in Germany were as brilliant and clear as yours!
Thank you for the extensively explaining video. Very helpful.
обожаю кардиологию и Генделя и ещё у Эрика приятный тембр и манера подачи! его лекции помогают мне обучать студентов, за что огромная благодарность! принтскриню конешно))
+ahha Спасибо! Я рад, что видео было полезно !
Lung sounds is on the short list of topics to get to soon. I'm just waiting to come across some better (i.e. more classic) examples of pathology to record and use for the video.
well describing clinical findind of cardiology .this is one of the best explication tutorial video
Thanks for explaining - makes more sense now. In AS the aortic and LV pressures follow each other more closely, so any difference takes longer to evolve, hence the more obvious crescendo-decrescendo.
A subtlety though, as you say, and unlikely to come up in med school exams :)
Keep up the great videos!
very easy to understand and I'm no medical student, great lecture :)
Awesome vedio
No body can teach you murmur better than this
Very helpful to understand the basic physiology of heart murmur!
Best video ever on heart murmur, thanks you sir from India 🇮🇳
Excellent presentation! Very helpful sir!
best teaching.. awesome presentation
I am a very good fan of strong medicine lectures.
Thank you Dr. Strong 😊
Heart murmurs are so difficult to learn, but this video helps me a lot. Thanks so much! So excellent video.
I've got 2 more days of heavy clinical responsibilities, then a long break of 100% teaching and admin, which will hopefully give me enough time between now and the end of the calander year to cover hypo and hypernatremia, hypo and hyperkalemia, coagulation disorders, lung sounds, surface tension, and if I'm lucky, hypertension. Will need to reassess where I'm at after Jan 1, but there had been a lot of prior requests for clinical biochem, so I may tackle that then.
it's grateful to hear you sir... best explained
excellent description and explanation of heart murmurs. Dr AK Lavania
Thanks for including the practice questions at the end; they were super helpful!
Thanks a lot for a great video! I'm a medicine student from the University of Buenos Aires, in Argentina.
Last week we had an 60 y/o patient with mitral stenosis due to rheumatic fever as it's still somewhat common to see here in public hospitals. anyways,thanks again!
I HAD TROUBLE TO UNDERSTAND THE TIMING ,SHAPE,AND THE PITCH OF THE MURNURS NOW ON WITH THIS LECTURE I'M TOTALLY CLEAR , I WANT TO THANK YOU FOR YOUR TIME AND YOUR DEDICATION. THANKS!
Incredibly useful video, thanks for making it so easy to understand !
Thank you Dr Strong. I nearly wanted to skip these 2 murmur thing lecture of you. I am so aversive of it. I anyhow think this is the great lecture. I am glad that i did
Wow, this is the most helpful video I think I’ve ever seen. Thank you!
Thank you so much. You're really appreciated by us all.
brilliant and awesome
crescendo and decrescendo of the decrescendo
in murmur's art ,
continous and the best all over the pericordium.
many thanks in deed...........
very good thank you. are you able to post the lecture slides at all please?
Amazing. Thanks doc for such organized presentation.
I watched this video, for the first time, the summer before starting medical school. I had absolutely no idea how I was going to digest all of that information.
Watched it again, today, as a second year medical student, and I was able to easily identify all of the Pathology within a few seconds of hearing the murmurs! Great video, and it was also very encouraging to rewatch.
My concern is, as a military vet, I've lost a good portion of my hearing (especially at high frequency). Is there any clinical tools that you recommend for amplifying the sounds (other than increasing preload)?
You could use a hearing aid from time to time no?
Excellent teaching tool! Thank you so much.
Very useful...looking forward for more videos.
Best murmur lectures 👌 😍
This is great really as educational resource. Thanks to doctor Eric.
Excellent and clear video. Thank you very much!
Phenomenal presentation 👏
Great efforts put in making this video. Thank you so much for the pains taken 🙏🏻🙏🏻
The best... Kindly put up a video with simultaneous ECHO cardiographic findings in valvular heart diseases...
10:23 aortic stenosis
10:42 AR
11:31 ar
11:45 mr
12:19 ms
12:46 ms
13:40 vsd high pitched
14:10 as harsh pitch
19:16 mr
22:20 as
24:28 ar
25:43 ms
27:43 diaphragm at apex ma
28:03 ms with bell
28:27 as + ar at apex
13:53 ms low pitch
Tear come to my eyes! So grateful...! Thank you so much.
Super thank you very much
your presentation is verynice.easily anyone can understand.upload more cardiology vedios.god bless you
Really well explained. I was just reviewing, but it was very helpful.
Interesting question if you don't mind: have you ever seen anticoags to decrease viscosity significantly enough to produce murmurs in some patients? I only ask because they are somewhat common among the older patients who we would be looking for murmurs in most often...
That's a great question! Conventional wisdom among doctors is that anticoagulants don't impact blood viscosity, and thus shouldn't impact the presence of murmurs. However, I wasn't sure where this conventional wisdom came from, so just did a brief literature search. As far as I can find, anticoagulants (e.g. heparin) do appear to decrease whole blood viscosity (conventional wisdom may be wrong...), though the studies I found were all very small, in relatively obscure journals, and most were relatively old (i.e. 1960s-1970s). I also couldn't find any trials discussing antiplatelet drugs (e.g. aspirin, Plavix) or even coumadin. I will say that anecdotally, in my own experience, I haven't personally observed an increased incidence of flow murmurs among patients on anticoagulation, or heard a flow murmur develop when starting a heparin infusion which then goes away when the heparin is stopped. I think it's certainly a plausible effect, but strongly suspect that even if it occurs, the effect size is quantitatively small enough as to not significantly impact an individual's diagnostic reasoning process when encountering a patient on anticoagulation who has a murmur. (i.e. I would not attribute a murmur to the use of a "blood thinner")
that is very useful and i really appreciate your effort, Dr Eric. Thanks!
Dr. Eric I just logged in to comment here.. this very lecture helped me learning such great deal that hours of cardiology lecture in my med school did not! Awesome!
Now i would like to put up an old request of mine.. Please please make a video on CT Brain. Thanks.
Megh o Roddur I think I remember this request from before! I sincerely do appreciate viewer requests and plan on honoring as many as possible. Unfortunately, I'm literally 200 topics behind at this point. For a while now, I've been focusing on topics which also either have strong relevance to the current curriculum here at Stanford, and/or topics which I know particularly well (because I can complete them a little bit faster). Head CTs don't fall into either category, so for now, it's on my extended list of topics to cover (in contrast to the "short" list). It's definitely a good suggestion though, and I will try my best to get to it - just can't predict when.
Eric's Medical Lectures
Thanks for your nice reply. Will be waiting for your next lecture ... :)
Thanku for such an awesome interactive vdo on murmurs.. really helpful !
Fantastic and well-spoken. Thank you from an M3.
Absolutely perfect!!! Thank you sooooo much, sir! Please please have more videos
Excellent video, very interesting.
Just one point - on describing the pressure gradient responsible for the pansystolic murmur of mitral regurgitation. Bit of a fudge? The pressure gradient is clearly crescendo-decrescendo if you subtract the LV pressure from the LA pressure; even more so than the LV / aorta pressure gradient that gives you the classic ejection crescendo-decrescendo murmur.
Aortic stenosis 10:21
Aortic regurgitation 10:41
Mitral Regurgitation 11:43
Mitral stenosis 12:20
Thanks a lot.was so helpful.a medical student from sri lanka
Thank you so much. Your lectures are amazing!
Absolutely Incredible.Nearly lodt hope on learning these stuffs properly
On the 3rd example, can you mention why the patient's height and exercise intolerance are relevant? It suggests Marfan syndrome to me, but would be satisfying to hear your take on it.
Yes, the height was a very subtle suggestion of possible Marfan's syndrome, which is associated with aortic root dilatation and aortic regurgitation (I can't believe I didn't mention that in the video!) The exercise intolerance was meant to be more indicative of chronic aortic regurg in general rather than Marfan specifically.
Thanks .. it's very clear and easy to understand
I will admit that the diagram in the lecture that shows the MR gradient intentionally underemphasizes it's crescendo-decrescendo nature, which I did to prevent confusion on a subtle point. Nice catch though. Hope that helps to clarify.
Hi. very good lecture. I want just to get some clarity on the 5th example. You said that it was a case of aortic stenosis and regurgitation. Can a valve that is stenotic regurgitate? I thought that if there is stenosis, the hole is small and blood may not regurgitate backward. Can it be a case of aortic stenosis superimposed to mitral regurgitation?