Download Innocent Systolic Murmur Chapter 13

Innocent Systolic Murmur
Chapter 13
Are G. Talking, MD, FACC
Instructor
Patricia L. Thomas, MBA, RCIS
Outline
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Characteristics of an Innocent Murmur
Characteristics of a Pathological Murmur
Where Systolic Murmurs May be Produced
Classification
Still’s Vibratory Systolic Murmur
Physiological Pulmonary Ejection Murmur
Supraclavicular Arterial Bruit, Venous Hum
Peripheral Pulmonary Stenosis of the Newborn
Innocent Aortic Systolic Murmur
Mammary Arterial Souffle
Straight-Back Syndrome & Pectus Excavatum
Characteristic of An Innocent Murmur
• Short (early to mid-systolic, except for the
venous hum
• Low to medium pitch
• Possibly a musical component
• Normal physiological splitting of S2
• Commonly found in children & early teen
year
• Isolated systolic murmurs in the elderly are
common & are frequently innocent
Characteristics of A Pathological Murmur
• Six Cardinal Clinical Signs
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Holosystolic Murmur
Harsh Murmur
Abnormal heart sound
Early or mid-systolic click
Grade III murmur or greater
Heard over the upper left sternal border
Where Systolic Murmurs May Be Produced
• Connection of the jugular, subclavian, & innominate
veins to SVC (venonus hum; supraclavicular spaces)
• Connection of RV to MPA (Pulmonary flow murmur; left
sternal border, 2nd 3rd intercostal spaces)
• Connection of the MPA to the RT & LT PA branches
(peripheral PS of the newborn; upper sternal border)
• Connection of the LV to the AO (Still’s murmur; apex)
• Connection of the Aortic Arch to the brachiocephalic
vessels (supra-clavicular arterial bruit; supracalvicular
fossa)
Classification
• Five types of innocent murmurs heard in
childhood:
– Still’s murmur or vibratory systolic murmur
– Physiological or functional pulmonary ejection
murmur
– Supraclavicular arterial bruit
– Venous hum
– Peripheral Pulmonary stenosis of the newborn
Still’s Vibratory Systolic Murmur
• Peak incidence in children 3 to 7 years, disappears at
puberty
• Musical, vibratory, low-frequency, early systolic
ejection murmur
• George F. Stills in 1909
• “A twanging sound”
• Turbulence produced by the physiological narrowing of
the LV outflow tract
• Listen with the bell of the stethoscope over the lower
mid-precordium or left lower sternal border & across to
the apex
Physiological Pulmonary Ejection Murmur
• Early systolic, crescendo-decrescendo, midfrequency, grade II
• Decreases during inspiration when a child sits
• Turbulent flow at the origin of the RT & LT
pulmonary arteries
• Listen with the diaphragm of the stethoscope
along the left sternal border in the 2nd to 3rd
intercostal space in supine position
• Heard best during inspiration
Supraclavicular Arterial Bruit
• Low to medium pitched, short, systolic, crescendodecrescendo murmur
• Unaffected by respiration; Grade II or Grade III
• Heard at any age mid-childhood & in 30% to 40% of
young adults
• Common in high-output conditions; anemia & anxiety;
prominent in trained athletes with slow heart rates &
high stroke volume
• Turbulence in the brachiocephalic or carotid arteries at
their branching from the aorta
• Listen with the bell of the stethoscope over the
supraclavicular fossa and over the sternomastoid muscle
with patient sitting
Venous Hum
• Blowing & Continuous extracardiac murmur that is
loudest during diastole
• Whining, roaring, or whirring; intensity varies form
faint to grade VI
• Louder under the inner edge of the right clavicle but
extends form the supraclavicular area over the right
internal jugular vein to the base of the heart
• Thrill is often present in children with venous hum
• Causes result form turbulent blood flow caused by two
streams of blood entering the SVC
• Listen with the bell of the stethoscope in the right
supraclavicular space
Peripheral Pulmonary Stenosis of the Newborn
• Short mid-systolic ejection murmur of medium
pitch & intensity is best heard in the second
intercostal space at the left sternal border
• Result of the turbulence caused when the MPA is
bigger or dilated than its branches
• Heard in newborns and premature infants
• Listen with the bell of the stethoscope during
systole at the upper left sternal border & axillary
areas
Innocent Aortic Systolic Murmur
• Short, crescendo-decrescendo, low to
medium pitch
• Children, systolic flow murmurs may be
secondary to any condition with increased
systemic cardiac output
• Listen with the bell of the stethoscope over
the aortic area
Mammary Arterial Souffle
• Described by Van Den Bergh in 1908
• A medium to high-pitched murmur, arising
in systole & possibly continuing into
diastole
• Listen with the diaphragm of the
stethoscope on the anterior chest wall over
the breast
Straight-Back Syndrome & Pectus Excavatum
• Decrease of the anteroposterior diameter of the
chest because of the loss of the normal degree of
kyphosis of the upper thoracic spine, straight-back
syndrome or because of the inward cavitation of
the sternum at the anterior chest wall
• Pulmonary systolic ejection murmur
• Exaggerated inspiratory splitting of S2
• X-ray revealing displacement of the heart to the
left, apparent cardiomegaly, pancake heart
THE END
OF
CHAPTER 13
Tilkian, Ara MD Understanding Heart Sounds and Murmurs,
Fourth Edition, W.B. Sunders Company. 2002, pp. 138-153