Chapter: Medicine and surgery: Cardiovascular system

Signs of Heart murmurs

Heart murmurs are the result of turbulent blood flow. Certain features of any murmur should be noted.

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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