NCLEX - Heart Murmurs

Here are key facts for NCLEX from the Hypertension Overview tutorial, as well as points of interest at the end of this document that are not directly addressed in this tutorial but should help you prepare for the boards. See the tutorial notes for further details and relevant links.

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• A murmur is an abnormal heart sound caused by turbulent blood flow, typically due to a valve disorder.
• Detected during auscultation with a stethoscope.

• Systolic murmurs: occur between S1 and S2 (during heart contraction)
• Diastolic murmurs: occur after S2 (during heart relaxation)
• Murmur timing helps determine which valve is affected

• Holosystolic murmur best heard at apex, radiates to axilla
• Symptoms: fatigue, dyspnea, palpitations
• Nursing interventions:
• Monitor for signs of heart failure
• Prepare client for echocardiogram
• Report new or worsening murmurs

• Harsh systolic crescendo-decrescendo murmur at right upper sternal border, radiates to carotids
• Symptoms: syncope, angina, dyspnea (SAD)
• Nursing concern: fall risk due to syncope
• Priority: assess for dizziness, fatigue, chest pain

• Diastolic murmur heard at left sternal border
• Wide pulse pressure and bounding pulses ("water-hammer pulse")
• Nursing actions:
• Monitor for signs of heart failure
• Encourage follow-up with cardiology

• Opening snap followed by diastolic rumble
• Common in patients with a history of rheumatic fever
• Nursing assessment:
• Monitor for dyspnea, fatigue, and atrial fibrillation
• Teach about anticoagulation if AF is present

• Mid-systolic click with late systolic murmur
• More common in young women
• May cause palpitations, lightheadedness
• Teach: avoid stimulants (e.g., caffeine), encourage hydration

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• Use bell and diaphragm of stethoscope
• Have patient lean forward (aortic) or lie in left lateral decubitus (mitral)
• Listen at specific valve locations:
• Aortic: 2nd right ICS
• Pulmonic: 2nd left ICS
• Tricuspid: 4th left ICS
• Mitral: 5th ICS, midclavicular line (apex)

• Heart failure: dyspnea, edema, crackles
• Atrial fibrillation: irregular HR, risk of stroke
• Embolism or clots in valve defects

• Medication adherence (e.g., anticoagulants for AF)
• Recognize worsening symptoms: fatigue, chest pain, SOB
• Avoid heavy exertion if symptomatic
• Regular echocardiograms as ordered

• Sudden worsening of murmur
• New onset of chest pain or syncope
• Signs of pulmonary edema: crackles, pink frothy sputum
• Signs of infective endocarditis: fever, petechiae, splinter hemorrhages

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AS: Systolic. Harsh, radiates to carotids. MR: Systolic. Radiates to axilla. AR: Diastolic. Wide pulse pressure. MS: Diastolic. Opening snap + rumble. MVP: Systolic. Click, increased with Valsalva.

• Clients with valve disease are at higher risk for infective endocarditis
• Teach about good dental hygiene
• Prophylactic antibiotics are only needed for high-risk conditions (e.g., prosthetic valve)

• Assess murmur before surgery or pregnancy
• Clients with severe valve disease may need cardiac clearance