Cardiology: Overview of Heart Murmurs

Heart Murmurs
Systolic murmurs are easiest to hear, but it is more difficult to decide what type they are          
Don’t forget to feel for the carotid to know whether they are systolic or diastolic!
-          Systole – between S1 and S2
-          Diastole – between S2 and S3
Left sided murmurs are best heard on Expiration
Right sided heart murmurs are best heard on Inspiration
Left sided murmurs are more clinically severe!
Infective Endocarditis can cause any murmur, but is most likely to cause regurgitation.
Connective tissue disorders (e.g. ankylosing spondylitis, rheumatoid arthritis, SLE, Marfan’s syndrome) can all cause valve defects. This occurs because the valve annulus (the ring of connective tissue that holds the valve cusps in place) may be affected, and is not longer able to properly support the valves.

Eponymous signs of aortic regurgitation
Austin Flint Murmur
Mid-diastolic murmur in the absence of mitral stenosis
Becker Sign
Accentuated Retinal Artery Pulsation
Corrigan’s Sign
Collapsing pulse (aka ‘WaterHammer pulse’)
De Musset sign
Head bobbing in time with the heart beat
Duroziez sign
Femoral artery sounds under compression
Gerhard Sign
Pulsatile spleen
Hill Sign
Higher systolic BP in the legs than in the arms
Mayne Sign
Drop in systolic BP >15mmHg when arm is raised
Mueller sign
Pulsatile uvula
Quincke sign
Exaggerated nailbed pulsations
Rosenback sign
Pulsatile Liver
Traube Sign
Loud sounds heard in systole and diastole over the femoral artery. Sometimes described as a pistol shot – heard with light compression
Grading Murmurs
If you hear a murmur you should be able to describe:
-          Systolic / Pansystolic
-          Duration – e.g. pan-systolic, ejection systolic
-          Site best heard at – e.g. Mitral area
-          Radiation – e.g. axilla
-          Grade
Murmurs can be graded on a scale of 1 – 6:
Very faint, can only be heard with stethoscope under optimal conditions
Only heard with stethoscope, but easily audible
Still only heard through the stethoscope, but loud
Similar to Grade 3, but also palpable
Louder than grade 4, and palpable thrill
Audible without the use of a stethoscope, and palpable thrill
Whats the difference between a thrill and a heave? 
  • A thrill - is a palpable murmur
  • A heave - is the result of LVH (Left ventricular hypertrophy) and feel liks something pushing your hand off the chest

 Notes by Tom Leach

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