cardiovascular disorders
Cardiac Auscultation
Systolic murmurs
Systolic murmurs may be normal or abnormal. They may be early, mid, or late systolic, or holosystolic (pansystolic). Systolic murmurs may be divided into ejection, regurgitant, and shunt murmurs. are due to turbulent forward flow through narrowed or irregular valves or outflow tracts (eg, due to Aortic Stenosis or Systolic ejection murmurs may occur without hemodynamically significant outflow tract obstruction and thus do not necessarily indicate a disorder. In normal infants and children, flow is often mildly turbulent, producing soft ejection murmurs. Older patients often have ejection murmurs due to valve and vessel sclerosis. During pregnancy, many women have soft ejection murmurs at the 2nd intercostal space to the left or right of the sternum. The murmurs occur because a physiologic increase in blood volume and cardiac output increases flow velocity through normal structures. The murmurs may be greatly exaggerated if severe anemia complicates the pregnancy. These murmurs are distinct from the venous hum sometimes caused by engorged breast vessels during pregnancy (mammary souffle). represent retrograde or abnormal flow (eg, due to Mitral Regurgitation , may originate at the site of the shunt (eg, Patent Ductus Arteriosus (PDA) , The 6th beat is a ventricular premature beat (VPB). The 7th beat illustrates post-VPB potentiation of the murmur due to increased left ventricular filling during the post-VPB compensatory pause. Recording provided by Jules Constant, MD. The murmur becomes audible only with inspiration (“in”) because inspiration decreases intrathoracic pressure, drawing more blood into the right ventricle and increasing right ventricular outflow. Recording provided by Jules Constant, MD. This holosystolic mitral regurgitation murmur maintains the same intensity throughout systole and extends from S1 to S2. Recording provided by Jules Constant, MD. The murmur of a ventricular septal defect is similar to that of mitral regurgitation but is louder at the left lower sternal border than at the apex. Recording provided by Jules Constant, MD. 