Heart murmurs are relatively prolonged

series of auditory vibrations of variable

intensity, quality,& frequency.
 It is due to turbulence that arises
when blood velocity increases due to flow or due
to flow through the constricted or irregular
orifice.
 FEATURES OF MURMERS

SYSTOLIC OR DIASTOLIC ?
WHERE IT IS BEST HEARED ?
WHERE DOES IT RADIATE TO ?
INTENSITY & THRILL ?
DURATION ?
PITCH & QUALITY .
LEVINE & FREEMAN’S GRADING
OF MURMURS
• SYSTOLIC MURMURS
• Grade
1 – very soft
2 – soft
3 – moderate
4 – loud with thrill
5 –very loud with thrill (heard with stethoscope)
6 – very loud with thrill (heard even when stethoscope Is
Slightly away from the chest wall)
• DIASTOLIC MURMURS
• Grade
1- very soft
2- soft
3- loud
4- loud with thrill
• MURMURS WICH OCCUR DURING ANY PART OF
THE WHOLE BODY (S1 TO S2) ARE KNOWN AS
SYSTOLIC MURMURS.
TYPES :-
EARLY SYSTOLIC MURMERS
MID SYSTOLIC MURMERS
LATE SYSTOLIC MURMURS
PAN SYSTOLIC MURMURS
• CAUSES:-
Ventricular septal defect

Acute severe tricuspid regurgitation

Mitral regurgitation
• CAUSES:-
Aortic stenosis

Pulmonary stenosis
Hypertrophic cardiomyopathy
CAUSES:-
Mitral valve prolapse syndrome
Tricuspid valve prolapse
syndrome
Papillary muscle dysfunction
• CAUSES:-

Mitral regurgitation
Ventricular septal defect
Tricuspid regurgitation
• MURMURS WHICH OCCURS DURING
ANY PART OF DIASTOLE ARE
KNOWN AS DIASTOLIC MURMURS.

• TYPES:-
1. Early diastolic murmurs
2. Mid diastolic murmurs
3. Late diastolic murmurs
 CAUSES:-
Aortic regurgitation
Pulmonary regurgitation
• CAUSES:-
Mitral stenosis
Tricuspid stenosis
• CAUSES:-
Mitral stenosis
Tricuspid stenosis
Atrial myxomas
Complete heart block
 a continuous murmur is one that
begins in systolic & extends through
the second heart sound into part or
whole of diastole.
 It is generated by flow of blood from a zone of high resistance to a zone
of low resistance without interruption during both systolic & diastolic.

 CAUSES:-
Persistence ductus arteriosus
Arterio venous shunt
• A MURMUR OCCURING THROUGH A SINGLE
CHANNEL & OCCUPYING MID SYSTOLE & EARLY
DIASTOLE & DOES NOT PEAK AROUND S2.
• e.g.
aortic stenosis with aortic regurgitation
pulmonary hypertension with pulmonary
regurgitation
• A MURMURS THAT OCCUPIES SYSTOLE AND
DIASTOLE & OCCURES THROUGH DIFFERENT
CHANNELS & DOES NOT PEAK AROUND S2.

• CAUSES:-
VENTRICULAR SEPTAL DEFECT
AORTIC REGURGITATION.
 SOFT SYSTOLIC MURMURS HEARED IN INDIVIDUAL
WITHOUT ANY CARDIAC ABNORMALITY.

 THEY ARE DUE TO INCREASED BLOOD FLOW

THROUGH THE VENTRICULAR OUTFLOW TRACKS.

 MAY BE HEARED IN
- CHILDREN (it is known as still’s murmurs)
- ADULTS (>50 years)
• THESE ARE MURMURS CAUSED BY
DILATATION OF HEART CHAMBER OR
VESSELS OR INCREASED FLOW.
• THESE ARE MURMURS WHICH CHANGE IN
CHARACTER OR INTENSITY FROM
MOVEMENT TO MOVEMENT.

• e.g.
Infective endocarditis
Atrial thrombus.