Heart murmurs
Heart murmurs are the result of turbulent blood flow. Certain features
of any murmur should be noted.
Timing to systole or diastole is achieved by palpation of the carotid
pulse whilst auscultating. A systolic murmur occurs at the same time as the
carotid pulse, whereas a diastolic murmur occurs in the pause between carotid
pulses. Murmurs are further described according to their relationship to the
cardiac cycle.
·
A systolic murmur may be
pansystolic when the first and second heart sounds cannot be heard separate
from the murmur . This occurs in mitral regurgitation, tricuspid regurgitation
and with a ventricular septal defect.
·
An ejection systolic murmur is a
crescendo–decrescendo murmur and the second heart sound can be heard distinct
from the end of the murmur. It is heard with aortic stenosis, pulmonary
stenosis and with an atrial septal defect (the sound being produced by
increased flow across the pulmonary valve).
·
A late systolic murmur is heard
in mitral valve prolapse.
·
An early diastolic murmur is
heard with aortic regurgitation, and a mid-late diastolic murmur is heard with
mitral stenosis.
The area in which the murmur is heard at the greatest intensity and any
radiation should be noted. This is most helpful when the flow of blood is
considered according to the lesion, for example aortic stenosis radiates to the
neck, mitral regurgitation radiates to the axilla. The intensity of the murmur
may be graded (see Table 2.2) and the pitch also noted.
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