1. 1. - M.A.Lateef Siddiqu
2. 2. Abnormal heart sounds are known as Cardiac Murmurs. Cardiac Murmurs are produced due to turbulent blood flow within the heart and great vessels i.e. Aorta and Pulmonary trunk. WHAT ARE CARDIAC MURMURS ?
3. 3. High Flow Velocity Small Orifice Diameter Low Kinetic Viscosity Turbulence MURMUR HOW IS A MURMUR PRODUCED?
4. 4. HOW ARE NORMAL HEART SOUNDS PRODUCED ? Normal heart sounds are Lub Dub. Lub is the first heart sound S1. It is long and loud. It is produced due to closure of atrio-ventricular (AV) valves i.e. Tricuspid and Mitral Valves. Dub is the second heart sound S2. It is short and sharp. It is produced due to closure of semi-lunar valves i.e. aortic valve and pulmonary valve. S1 and S2 are best heard at apex beat i.e. left 5th intercostal space in the mid-clavicuar line.
5. 5. Third heart sound S3 is also produced during rapid ventricular filling. It is a short and low pitched sound which is normally not heard by the stethoscope, it can be heard only by using Microphone. Third heart sound can be heard in children and Atheletes. In pathological conditions like Aortic Regurgitation, Cardiac Failure and Cardio Myopathy it can be heard by Stethoscope. It can be heard best with the help of bell of Stethoscope at the apex beat area when the patient is in Left Lateral Position. HOW ARE NORMAL HEART SOUNDS PRODUCED ?
6. 6. Fourth heart sound S4 is also inaudible sound. It is produced during Atrial Systole. It is a short and low pitched sound which is audible in Pathological Conditions like Ventricular Hypertrophy, Aortic Stenosis. It can be heard best with the help of bell of Stethoscope at the apex beat area when the patient is in Supine or Left Semi- lateral Position. HOW ARE NORMAL HEART SOUNDS PRODUCED ?
7. 7. CLASSIFICATION OF MURMURS SYSTOLIC MURMURS DIASTOLIC MURMURS CONTINUOUS MURMURS
8. 8. SYSTOLIC MURMURS Systolic murmurs begin with or after the first heart sound (S1) and terminate at or before the component (A2 or P2) of the second heart sound (S2).
9. 9. Incompetence of Atrio Ventricular Valves. Stenosis of Semi lunar Valves. Septal Defect. Coarctation of Aorta. Anaemia. CAUSES RESPONSIBLE FOR SYSTOLIC MURMUR
10. 10. MITRAL REGURGITATION Retrograde flow from the left ventricle through an incompetent mitral valve into the left atrium is known as Mitral Regurgitation. Time- pan/holo systolic Location- apex beat area, radiates to left axilla Best Heard- when patient lies on left side Characteristics- soft, high-pitched, blowing Associated Symptoms- MV prolapse, MV myxomatous degeneration, rheumatic heart disease, cardiomyopathy, endocarditis
11. 11. TRICUSPID REGURGITATION Retrograde flow from the right ventricle through an incompetent tricuspid valve into the right atrium is known as Tricuspid Regurgitation. Time- pan/holo systolic Location- left 3rd, 4th inter costal spaces Best Heard- when patient inspires deeply Characteristics- high-pitched, louder with inspiration Associated Symptoms- Jugular Venous Pulsation, TV myxomatous degeneration, rheumatic heart disease, cardiomyopathy, Systolic hepatic Pulsations.
12. 12. Narrowing of the aortic valves is known as aortic stenosis. It causes obstruction of blood flow from the left ventricle into the ascending aorta. Time- mid-systolic Location- right 2nd intercostal space, radiates to carotid region Best Heard- when patient bends slightly forwards Characteristics- harsh, loud, may have associated thrill, ejection click Associated Symptoms- older age, bicuspid aortic valve, rheumatic fever, left ventricular hypertrophy AORTIC STENOSIS
13. 13. PULMONARY STENOSIS Time- Mid-Systolic Location- Left 2nd inter costal space Best Heard- when patient bends slightly forward and breathes out Characteristics- harsh, loud, may have associated thrill, ejection click Associated Symptoms- older age, rheumatic fever, Ventricular septal defect, Dextro position of Aorta, Right Ventricular hypertrophy Narrowing of the pulmonary valve causing obstruction of flow from the right ventricle into the pulmonary trunk is known as Pulmonary Stenosis.
14. 14. ATRIAL SEPTAL DEFECT A congenital abnormality in which blood flows from left atrium into right atrium through a hole is known as Atrial Septal Defect. Time- Mid systolic Location- 3rd, 4th left inter costal spaces Best Heard- when patient bends slightly forwards Characteristics- harsh, loud, splitting of heart sound Associated symptoms- cyanosis, dyspnoea, ventricular hypertrophy
15. 15. VETRICULAR SEPTAL DEFECT A congenital abnormality in which blood flows from high pressure LV to low pressure RV through a hole is known as Ventricular Septal Defect. Time- pan/holosystolic Location- 3rd, 4th, 5th left inter costal spaces Best Heard- when patient lies on left side Characteristics- harsh, loud Associated symptoms- alone or associated with pulmoary stenosis
16. 16. DIASTOLIC MURMURS Diastolic murmurs begin with or after the S2 and end at or before the subsequent S1.
17. 17. Stenosis of Atrio Ventricular Valves. Incompetence of Semi lunar Valves. CAUSES RESPONSIBLE FOR DIASTOLIC MURMUR
18. 18. MITRAL STENOSIS Obstruction of flow from left atrium to left ventricle because of a narrowed mitral orifice is known as Mitral Stenosis. Time- Mid-Diastolic Location- Apex Best Heard- with bell while patient lies on left side Characteristics- low pitched Associated Symptoms- Rheumatic fever
19. 19. TRICUSPID STENOSIS Obstruction of flow from right atrium to right ventricle because of a narrowed Tricuspid orifice is known as Tricuspid Stenosis. Time- Mid-Diastolic Location- Left 2nd, 3rd inter costal space Best Heard- with bell while patient bends forwards Characteristics- low pitched Associated Symptoms- Rheumatic fever, almost always accompanies with mitral stenosis
20. 20. AORTIC REGURGITATION Retrograde flow from the aorta into the left ventricle through incompetent aortic cusps is known as Aortic Regurgitation. Time- Early-Diastolic Location- 2nd-4th left intercostal spaces Best Heard- during expiration with patient leaning forwards Characteristics- high-pitched, blowing Associated Symptoms- aortic root degeneration, rheumatic heart disease, VSD, aortic valve prolapse (kids)
21. 21. CONTINUOUS MURMURS Continuous murmurs are not confined to either phase of the cardiac cycle but instead begin in early systole and proceed through S2 into all or part of diastole, they are uninterrupted by valve closure.
22. 22. Failure of the ductus arteriosis (duct between pulmonary artery and aorta) to close after birth Time- Continuous Location- upper left sternal border at the level of 2nd inter costal space Characteristics- machine-like Associated Symptoms- aorta to pulmonary shunt, cyanosis PATENT DUCTUS ARTERIOSIS
23. 23. Pericardial Rubs occurs due to friction produced by heart movements. Venous Hum is present at the upper region of chest, produced due to obstruction in JVF. PERICARDIAL RUBS & VENOUS HUMS