Heart Murmurs

[@ravichand94]

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.

[@battheman777]

Aortic stenosis 10:21 Aortic regurgitation 10:41 mitral regurgitation 11:43 Mitral stenosis 12:20 quizzes start at 19:05

[@medicinekeysformrcps5025]

The best illustration I have ever watched about murmurs. I am really thankful.

[@compaqNC8230]

This is by far, one of the best heart murmur tutorials on youtube. Thanks!

[@justamedico1945]

best one.. this person has really has a knack for teaching

[@StrongMed]

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!

[@nazellina]

This is absolutely the best video on this topic on youtube. God, it made everything so clear

[@StrongMed]

Thanks!

[@StrongMed]

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.

[@dithishetty6120]

Simple, clear, and short video describing both systolic and diastolic murmurs .

[@MRradicalmj]

This is the BEST, most useful, clearest and most practical lecture on heart sounds, in my experience. Thank you soooo much for sharing.

[@limweiyang2464]

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

[@Thugbert0]

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.

[@MarcusTheMedic]

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

[@alexandrajacobsen9319]

This is the best video I've seen about heart murmurs. The audio clips are very helpful!!

[@tomingebrigtsen8976]

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.

[@vishnus935]

3rd year med student from India. I love your videos and they're really helpful. Thanks a lot!

[@MBHarsh]

+Vishnu S Cool same here, which college?

[@armandohasudungan]

Ver Nice~

[@StrongMed]

+Armando Hasudungan Thanks! I love your channel, and have referred numerous people to it.

[@TheRealStoicM]

two great legends!!!nice

[@Testango]

You are a hero dear Professor!

[@Zumbador]

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.

[@sjc2477]

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!

[@richardoyama8417]

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.

[@gohealthy1111]

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!!

[@owellwenevermind]

Dr. Strong! This is fantastic! Thank you for making this available on the web!

[@deedeefleur]

One of the best lectures on heart sounds and murmurs!! Thank youuuu!!

[@NitinSahuPHOTOS]

GREAT. VERY VERY INFORMATIVE. EXCELLENT NARRATION. SIMPLICITY AT ITS BEST.

[@tangoz811]

thank you for the thorough yet simplified explanation of murmurs. cheers

[@richardkay5639]

The best murmurs tutorial-clear and concise.

[@priya0112]

One of the best murmur lecture I've seen. Thank you so much!

[@amirmansy5573]

Best lecture on heart murmurs i have ever watched

[@danielsevell5732]

What a resource, and for free? Thank you so much, such a thoughtful act my friend!!

[@StrongMed]

Laura, I'm glad you found them helpful. The music is Handel's Suite No. 1 in F major, Hornpipe.

[@laurencelesser4235]

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!"

[@AiamFasha]

Thank you very much for the lecture! I'm a medical student from brazil, this helped me a lot!

[@StrongMed]

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.

[@coolbluelights]

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!

[@arankalle4354]

Best video lecture on the topic. Great doctor teacher. Happy doctor's day sir !( 1july22)

[@babalwatini5680]

Thank you so much this makes more sense to me as a medical student.

[@srahul006]

very good lecture helped a lot to understand murmurs of heart

[@SShootingstars]

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.

[@johnsacrimoni2102]

This was an exceptional Murmur tutorial better than anything Kaplan has put out ! Thank you so much Doctor!!!

[@elyarzeynalov6552]

Thank you for the extensively explaining video. Very helpful.

[@StrongMed]

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.

[@6048James]

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!

[@Rsingh07NP]

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!

[@siphomgqibandaba3023]

very useful, I finally understood the differences, loud and clear..

[@ishanmewara44]

it's grateful to hear you sir... best explained

[@dr.x3495]

Very helpful to understand the basic physiology of heart murmur!

[@surajutmani367]

Excellent presentation! Very helpful sir!

[@rpb2752]

this clip is fantastic, thanks a lot Eric. I wish lectures here in Germany were as brilliant and clear as yours!

[@ahhadoc]

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))

[@StrongMed]

+ahha Спасибо! Я рад, что видео было полезно !

[@rouhioj]

very good thank you. are you able to post the lecture slides at all please?

[@Luiscostaortega]

very easy to understand and I'm no medical student, great lecture :)

[@StrongMed]

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.

[@eez7360]

Thank you so much. You're really appreciated by us all.

[@ayoubmahammedi9679]

well describing clinical findind of cardiology .this is one of the best explication tutorial video

[@juandvcmd]

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!

[@StrongMed]

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.

[@anillavania4646]

excellent description and explanation of heart murmurs. Dr AK Lavania

[@kotetsu131]

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...

[@StrongMed]

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")

[@mansoorali3040]

Awesome vedio No body can teach you murmur better than this

[@stonecold8762]

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.

[@venugopalreddychukka2112]

I am a very good fan of strong medicine lectures. Thank you Dr. Strong 😊

[@randomstuff3360]

Best video ever on heart murmur, thanks you sir from India 🇮🇳

[@polycarpemakinga2460]

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?

[@Oath555]

Tear come to my eyes! So grateful...! Thank you so much.

[@rupsolomontalluri5837]

Super thank you very much

[@regd74]

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!

[@مجاهدابراهيم-ه9ش]

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...........

[@deckard578]

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!

[@6048James]

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.

[@taxijade]

Incredibly useful video, thanks for making it so easy to understand !

[@MikeBirkhead]

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)?

[@serseriherif9530]

You could use a hearing aid from time to time no?

[@mehediforever]

Amazing. Thanks doc for such organized presentation.

[@drraghavendrabl7424]

best teaching.. awesome presentation

[@nilawaranup]

This is great really as educational resource. Thanks to doctor Eric.

[@udaynarravula8400]

your presentation is verynice.easily anyone can understand.upload more cardiology vedios.god bless you

[@Michael75557]

Absolutely Incredible.Nearly lodt hope on learning these stuffs properly

[@georgejin2348]

Heart murmurs are so difficult to learn, but this video helps me a lot. Thanks so much! So excellent video.

[@oceanflavored228]

Thanks for including the practice questions at the end; they were super helpful!

[@ZinjNut]

Excellent and clear video. Thank you very much!

[@MUHAMMADULUSYARKhan]

Thanku for such an awesome interactive vdo on murmurs.. really helpful !

[@gregmcbroom3943]

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.

[@StrongMed]

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.

[@Dragongirl4776]

Excellent teaching tool! Thank you so much.

[@sunving]

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

[@sriramkumar182]

The best... Kindly put up a video with simultaneous ECHO cardiographic findings in valvular heart diseases...

[@coolwatcher6653]

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

[@johnklens8812]

Wow, this is the most helpful video I think I’ve ever seen. Thank you!

[@kasunisuwandika1907]

Thanks a lot.was so helpful.a medical student from sri lanka

[@robertoperezmarchese2572]

Much appreciated, Dr. Strong... any plans for future vids??

[@KidsNNeurons]

Absolutely perfect!!! Thank you sooooo much, sir! Please please have more videos

[@NARAYANNE007]

Very useful...looking forward for more videos.

[@auyesugi1]

Thank you so much. Your lectures are amazing!

[@skmiraduzzaman685]

Best murmur lectures 👌 😍

[@rekhakadam6393]

Great efforts put in making this video. Thank you so much for the pains taken 🙏🏻🙏🏻

[@michaelh1830]

Really well explained. I was just reviewing, but it was very helpful.

[@victorsosu1003]

lost for words, unbelievable lecture

[@dannyreyes3294]

Fantastic and well-spoken. Thank you from an M3.

[@kyawzeya3960]

that is very useful and i really appreciate your effort, Dr Eric. Thanks!

[@StrongMed]

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.

[@sureshbalusamy4882]

thank you very much.very useful and easily understandable

[@twebazeannaclet]

Thanks .. it's very clear and easy to understand