What you need to know about heart murmur. *(Including photos and sounds of each type)

1. Heart murmurs
Presented by:
Racheen S. Haji
Nizar H. Ibrahim
Parwar I. Tahir
University of zakho
Faculty of medical sciences
School of medicine
Surgical department

3. Anatomy of the heart

5. Heart murmur
• Is an extra or unusual sound added to normal heartbeat sound which
are caused by turbulent flow within the heart and great valves.
• Normal heartbeats make a “lub-DUB” sound.
• Heart murmur sound like whooshing or swishing noise.
• These sounds can be heard by stethoscope.
 Innocent murmurs: might occur in healthy heart,
when stroke volume is increased. E.g. pregnancy
and athletes with resting bradycardia or children
with fever.

6. Etiology
Valvular stenosis
Valvular ins

7. Etiology
ar stenosis
Valvular insufficiency
Congenital an

8. Etiology
sufficiency
Congenital anomalies
Increased bl

9. Etiology
Congenital anomalies
Increased blood flow

11. Site
Character
Radiation
Intensity
Pitch
Timing

15. +(Atrial septal defect, Patent ductus arteriosus)

16. +(Ventricular septal defect, Aortic regurgitation)

18. • CRESCENDO
-the murmur will progressively peak in intensity
• DECRESCENDO
-the murmur intensity will peak early and
progressively decrease in intensity
• CRESCENDO-DECRESCENDO
-the intensity of the murmur will increase
progressively and peak, then will decrease
progressively
• PLATEAU
-the murmur intensity is uniform throughout

22. Intensity
Grade
Barely audible
1
Audible but soft
2
Easily audible
3
Easily audible and associated with thrill
4
Easily audible, associated with thrill and heard when stethoscope partially
off the chest
5
Easily audible, associated with thrill and heard when stethoscope is near
the chest
6

23. • It depends upon pressure gradient and volume of flow across a
particular structure.
• High pitch murmur occurs in:
• Aortic regurgitation
• Mitral regurgitation
• Low pitch murmur occurs in:
• Mitral stenosis
• Tricuspid stenosis

24.  Systolic murmur: it occurs between S1 and S2, it might be pathological,
physiological, or innocent.
 Diastolic murmur: it occurs between S2 and next S1, are always pathological.
 Continuous murmur: it occurs throughout systole and diastole, Are always
pathological except in venous hum (Caused by turbulence flow across the jugular venous
system).
Timing

25. Systolic murmur
Timing
Ejection systolic murmur Pan systolic murmur Late systolic murmur

26. Systolic murmur
Timing
Ejection systolic murmur
Pan systolic
murmur
Late systolic
murmur
Aortic stenosis
Pulmonary stenosis
Atrial septal defect
HOCM
Innocent murmur

27. Systolic murmur
Ejection systolic
murmur
Pan systolic murmur
Late systolic
murmur
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
Timing

28. Systolic murmur
Timing
Ejection systolic
murmur
Late systolic murmur
Pan systolic
murmur
Mitral valve prolapses

29. Diastolic murmur
Timing
Early diastolic murmur Mid diastolic murmur

30. Diastolic murmur
Timing
Early diastolic murmur
Mid diastolic murmur
Aortic regurgitation
Pulmonary regurgitation

31. Diastolic murmur
Timing
Early diastolic murmur
Mid diastolic murmur
Mitral stenosis
Tricuspid stenosis

32. Continuous murmur
Timing
Patent ductus arteriosus (PDA) murmur
Murmurs of collateral of Tetralogy of Fallot and coarctation of aorta
AV fistula (systemic, coronary or pulmonary).

33. the '10 S' test of a normal murmur:

34. the '10 S' test of a normal murmur:

35. the '10 S' test of a normal murmur:

36. the '10 S' test of a normal murmur:

37. the '10 S' test of a normal murmur:

38. the '10 S' test of a normal murmur:

39. the '10 S' test of a normal murmur:

40. the '10 S' test of a normal murmur:

41. the '10 S' test of a normal murmur:

42. the '10 S' test of a normal murmur:

43. the '10 S' test of a normal murmur:

44. the '10 S' test of a normal murmur:

46. Approach to the patient
 Historical finding
 Physical examination
 Investigation
 Treatment

52. History
• Personal history:
• Trisomy 21
• Turner syndrome
• Marfan syndrome
• Major congenital defects of other organ
systems
• Frequent respiratory infections
• Kawasaki disease
• Rheumatic fever
• Family history:
• CHD
• Sudden cardiac death or hypertrophic
cardiomyopathy
• Sudden infant death syndrome
• Prenatal or perinatal history:
• In utero exposure to alcohol or other
toxins
• In utero exposure to selective serotonin
reuptake inhibitors or other potentially
teratogenic medication
• Intrauterine infection
• Maternal diabetes mellitus
• Preterm delivery

54. Physical examination
• Cardiovascular findings
• Abnormal S2
• Capillary refill
• Edema
• Substernal heave
• Systolic ejection click
• Weak or absent femoral pulses
• Gastrointestinal findings
• Ascites
• Hepatomegaly
• Location of liver signals
• Abnormal growth (height and weight
plotted on growth chart)
• Abnormal vital signs (compared with
age-adjusted norms)
• Adventitial breath sounds (wheezing,
rales, rhonchi, pleural rub)

56. Investigations
Echocardiogram.
Chest X-ray.
Electrocardiogram (ECG or EKG).
Cardiac catheterization.

58. Treatment

59. Medications
• Blood thinners (anticoagulants).
• Water pills (diuretics).
• Angiotensin-converting enzyme (ACE) inhibitors.
• Beta blockers.

60. Surgery or other procedures
• During heart valve repair, a surgeon might:
• Patch holes in a valve
• Separate valve leaflets that have fused
• Replace the cords that support the valve
• Remove excess valve tissue so that the valve can close tightly
• Tighten or reinforce the ring around a valve
• Heart valve surgery may be done as:
• Open-heart surgery
• Minimally invasive heart surgery
• Robotic heart surgery
• A procedure using flexible tubes (catheter procedure)

61. Thanks for your attention.
Any questions…