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Heart MurmurPROBLEM BASED LEARNING (PBL)

PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB

BACHELOR MEDICINE AND SURGERY (MBBS)

UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

What is heart murmur?

• A heart murmur is an extra or unusual sound heard due to turbulent blood flow within the heart during a heartbeat .

• Normal heartbeats make a "lub-DUPP" or "lub-DUB" sound.

• Heart murmur sound like a whooshing or swishing noise.

• Doctors can hear these sounds and heart murmurs using a stethoscope. (auscultation)

• Most murmurs are normal or harmless.Normal murmurs are caused by the normal flow of blood through the heart and large vessels near the heart. The murmur may come and go over time. Some things that can increase blood flow and cause heart murmur to be heard include:

- Exercise- Pregnancy- Extreme anxiety- Anemia- Fever- Hyperthyroidism

But some heart murmurs can signal an underlying heart problem.

Systolic Murmurs

• Ejection systolic murmurs: reach a peak midway between 1st and 2nd heart sounds and don't run into the 2nd heart sound. Usually maximal at the upper sternal borders, and possible causes include:

• Aortic stenosis. (most frequent)• Pulmonary stenosis.• Coarctation of the aorta: murmur is heard over

the back, particularly in the interscapular region.• Hypertrophic obstructive cardiomyopathy.

• Pansystolic murmurs have uniform intensity between 1st and 2nd heart sounds and merge with the 2nd heart sound, which is therefore not distinguishable. Those at the lower sternal border are more likely to be of regurgitanttype due to:

• Ventricular septal defect.

• Atrial septal defect.

• Mitral or tricuspid regurgitation.

Diastolic murmurs

• Early diastolic murmurs: occur just after the 2nd heart sound. They are high-pitched and easily missed.

• Causes include aortic valve regurgitation and pulmonary valve regurgitation or with pulmonary hypertension.

• Mid or late diastolic murmurs: are low-pitched and occur at the lower sternal borders in mitral stenosis or tricuspid stenosis.

Continous murmurs

• These murmurs are due to blood flow from a high pressure chamber or vessel to a lower pressure system.

• Patent ductus arteriosus. PDA is an abnormal connection between the aorta and the pulmonary artery, which normally should be closed in infancy. Since aortic pressure is higher than pulmonary pressure, a continuous murmur occurs. This murmur is often described as a machinery murmur, or Gibson's murmur