An inetgrated CVS disease

Traits	MS	MR/VSD	AS	AR
Inspection	Cardiac impulse if RVH	Same	Same	Same
Apex beat	Position normal Deviation if RVH Tapping	Position shifted downwards and to left(VSD-Not) Thrusting(?)	Position shifted downwards and to left Thrusting(D)-LV pr. overload Double apical(H)	Position shifted downwards and to left Heaving(H)
Thrill	Diastolic(Here)	Systolic(Here)	Systolic(Here)	Diastolic(Here)
HS	1st HS loud all area ,more prominent in mitral area 2nd HS normal all area Loud P2 in PTN	1st HS soft in mitral area and normal in all other(VSD-Normal all area) 2nd HS normal all area 3rd HS maybe	A2 soft P2 normal ---Opposite in TOF S1 normal all area 4th HS maybe	A2 absent P2 normal S1 normal all area
Murmur	LLRRMM- Low pitched localised rough rumbling MDM best heard with bell on left lateral position with breath holding expiration with presystolic accentuation #MS with AF-No presystolic accentuation #ASD-Absence of LAE and kerley B line	Pansystolic with radiation(VSD-not) to left axilla ,reduced on insp. and prominent on expi. #MR with MS-MDM #TR- ·         Prominent on inspiration and reduced on expi. ·         No radiation. ·         No thrill ·         Raised JVP with prominent V wave ·         Enlarged tender liver	Harsh , low pitched ,rough rasping ,ejection systolic with radiation to neck #A.slcerosis- ·         Apex-Normal ·         Thrill-Absent ·         A2-Normal	High pitched ,blowing early diastolic ,best heard with diaphragm at lower left sternal edge ,leaning forward with breath holding expiration #Soft mid diastolic murmur at mitral area is Austin flint murmur
Opening snap	Medial to mitral area