STUDY - Technical - New Dacian's Medicine
Murmur
(Classical / Allopathic Medicine)
Murmurs are
auscultatory sounds heard within the heart chambers or major
arteries. They're classified by their timing and duration in
the cardiac cycle, auscultatory location, loudness,
configuration, pitch, and quality.
Timing can be
characterized as systolic, holosystolic (continuous throughout
systole), diastolic, or continuous throughout systole and
diastole; systolic and diastolic murmurs can be further
characterized as early, middle, or late. Location refers to
the area of maximum loudness, such as the apex, the lower left
sternal border, or an intercostal space. Loudness is graded on
a scale of 1 to 6, with 1 signifying the faintest audible
murmur. Configuration, or shape, refers to the nature of
loudness - crescendo, decrescendo, crescendo-decrescendo,
decrescendo-crescendo, plateau (even), or variable (uneven).
The murmur's pitch may be high or low. Its quality may be
described as harsh, rumbling, blowing, scratching, buzzing,
musical, or squeaking.
Identifying
common murmurs
The timing and configuration of a murmur can help you identify its underlying cause. Learn to recognize the characteristics of these common murmurs.
Aortic insufficiency (chronic) - Thickened valve leaflets fail to close correctly, permitting blood backflow into the left ventricle.
Aortic stenosis - Thickened, scarred, or calcified valve leaflets impede ventricular systolic ejection.
Mitral prolapse - An incompetent mitral valve bulges into the left atrium because of an enlarged posterior leaflet and elongated chordae tendineae.
Mitral insufficiency (chronic) - Incomplete mitral valve closure permits blood backflow into the left atrium.
Mitral stenosis - Thickened or scarred valve leaflets cause valve stenosis and restrict blood flow.
Murmurs can reflect accelerated blood flow through normal or abnormal valves; forward blood flow through a narrowed or irregular valve or into a dilated vessel; blood backflow through an incompetent valve, septal defect, or patent ductus arteriosus; or decreased blood viscosity. Typically the result of an organic heart disease murmur occasionally signals an emergency - for example, a loud holosystolic murmur after an acute myocardial infarction may signal papillary muscle rupture or ventricular septal defect. Murmurs may also result from the surgical implantation of a prosthetic valve.
The timing and configuration of a murmur can help you identify its underlying cause. Learn to recognize the characteristics of these common murmurs.
Aortic insufficiency (chronic) - Thickened valve leaflets fail to close correctly, permitting blood backflow into the left ventricle.
Aortic stenosis - Thickened, scarred, or calcified valve leaflets impede ventricular systolic ejection.
Mitral prolapse - An incompetent mitral valve bulges into the left atrium because of an enlarged posterior leaflet and elongated chordae tendineae.
Mitral insufficiency (chronic) - Incomplete mitral valve closure permits blood backflow into the left atrium.
Mitral stenosis - Thickened or scarred valve leaflets cause valve stenosis and restrict blood flow.
Murmurs can reflect accelerated blood flow through normal or abnormal valves; forward blood flow through a narrowed or irregular valve or into a dilated vessel; blood backflow through an incompetent valve, septal defect, or patent ductus arteriosus; or decreased blood viscosity. Typically the result of an organic heart disease murmur occasionally signals an emergency - for example, a loud holosystolic murmur after an acute myocardial infarction may signal papillary muscle rupture or ventricular septal defect. Murmurs may also result from the surgical implantation of a prosthetic valve.
HISTORY:
Ask the patient if the murmur is a new discovery or if it has been known since birth or childhood.
Ask the patient if he has experienced associated signs and symptoms, particularly palpitations, dizziness, syncope, chest pain, dyspnea, and fatigue.
Review the patient's medical history, noting especially rheumatic fever, heart disease, or heart surgery, particularly prosthetic valve replacement.
Ask the patient if the murmur is a new discovery or if it has been known since birth or childhood.
Ask the patient if he has experienced associated signs and symptoms, particularly palpitations, dizziness, syncope, chest pain, dyspnea, and fatigue.
Review the patient's medical history, noting especially rheumatic fever, heart disease, or heart surgery, particularly prosthetic valve replacement.
PHYSICAL
ASSESSMENT:
When you discover a murmur, try to determine its type through careful auscultation. (See Identifying common murmurs.) Use the bell of your stethoscope for low-pitched murmurs; the diaphragm for high-pitched murmurs.
Perform a systematic physical assessment. Note especially the presence of cardiac arrhythmias, jugular vein distention, peripheral edema, and such pulmonary signs as dyspnea, orthopnea, and crackles.
Palpate the liver for size and tenderness.
When you discover a murmur, try to determine its type through careful auscultation. (See Identifying common murmurs.) Use the bell of your stethoscope for low-pitched murmurs; the diaphragm for high-pitched murmurs.
Perform a systematic physical assessment. Note especially the presence of cardiac arrhythmias, jugular vein distention, peripheral edema, and such pulmonary signs as dyspnea, orthopnea, and crackles.
Palpate the liver for size and tenderness.
SPECIAL
CONSIDERATIONS:
Prosthetic valve replacement can cause various murmurs, depending on the location, valve composition, and method of operation.
Prosthetic valve replacement can cause various murmurs, depending on the location, valve composition, and method of operation.
PEDIATRIC
POINTERS:
Pathognomonic heart murmurs in infants and young children usually result from congenital heart disease, such as atrial and ventricular septal defects.
Innocent murmurs, such as Still's murmur, are commonly heard in young children, but typically disappear in puberty.
Pathognomonic heart murmurs in infants and young children usually result from congenital heart disease, such as atrial and ventricular septal defects.
Innocent murmurs, such as Still's murmur, are commonly heard in young children, but typically disappear in puberty.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include electrocardiography and echocardiography.
Instruct the patient on what to expect from diagnostic testing, which may include electrocardiography and echocardiography.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.