Systolic and Diastolic Murmurs
Introduction
Introduction The sound produced by turbulence caused by abnormal cardiovascular structure or hemodynamics and blood in the heart or large blood vessels is a group of vibrations with long durations and different frequencies and amplitudes. The murmur often helps in the diagnosis of the disease and can also be seen in normal people.
Cause
Cause
The production of heart murmurs accelerates blood flow in the heart or large blood vessels (such as anemia after exercise), and the blood flows from the stenosis to the wide area (valvular stenosis such as mitral stenosis, or enlargement of the heart or expansion of the large vessel) Relatively narrow), blood reflux (such as insufficiency of the valve), blood flow through abnormal channels (such as ventricular septal defect, patent ductus arteriosus, as in the aneurysm where blood flows from the normal blood vessels into the enlarged part) or free to vibrate in the blood The flakes (such as the rupture of the papillary muscles in the heart, disturbing the blood to cause whirls), turbulence occurs to vibrate the cardiovascular wall and produce noise. The noise can be completely separated from the heart sound, or it can be continuous with it, or even completely cover the heart sound. The murmur can be heard by the stethoscope, or it can be recorded by the heart sound map. On the heart sound map, it is a set of mixed vibrations with long duration, different rates and different amplitudes. The murmurs can be found in normal people (benign murmurs, such as children and young people, after exercise, during pregnancy), as well as in cardiovascular diseases and other diseases (such as rapid blood flow during fever, resulting in rapids and eddies). The murmur can be divided into functional and organic murmurs according to whether the heart has organic lesions. Functional murmurs occur in the heart without structural changes. It can be physiological, found in normal people, and can also be seen in certain pathological conditions (such as anemia, fever). Organic murmurs often help to diagnose anatomical changes in heart disease (such as stenosis of the valve orifice, abnormal passages) and infer the etiology (such as rheumatism, congenital, syphilis). However, some organic heart disease has no noise. From the appearance time, the murmur can be divided into systolic murmur (physiological murmur is in systole, but systolic murmur can be pathological), diastolic murmur (both pathological) and continuous murmur (such as patent ductus arteriosus, Aortic aneurysm). Contraction and diastolic murmurs can be divided into early, middle and late stages.
Examine
an examination
Related inspection
ECG heart sound map check
The auxiliary measures for sound diagnosis include:
1 Breathing, most of the systolic and diastolic murmurs from the right heart are enhanced when inhaling, and the opposite is true when exhaling. Therefore, breathing can distinguish the aortic valve from the pulmonary valve, mitral valve and tricuspid regurgitation.
2 position, supine to make the tricuspid regurgitation, the murmur of the semilunar stenosis is enhanced, and the murmur of the aortic stenosis is weakened. In the left lateral position, especially in the first 6 to 10 cardiac cycles, the murmur of the mitral stenosis is enhanced. Rapid squatting can increase venous return and raise blood pressure, which can weaken or disappear the aortic subvalvular stenosis and mitral valve prolapse. The right to left shunt of Fallot's quadruple is reduced, and the funnel is narrow. Increased blood flow, prolonged noise increase.
3 The length of the cardiac cycle, after the long period of atrial fibrillation or the premature contraction compensation interval, the systolic jet murmur of the left and right outflow tract obstruction is enhanced, while the full systolic reflux murmur from the mitral valve and ventricular septum is absent. Variety.
4 sustained Valsalva's movement (the glottis closed forcibly exhaled to increase intrathoracic pressure, affecting venous blood return to the blood), reducing venous return, blood pressure, ventricular volume reduction, and aortic stenosis The murmur is enhanced, and the late systolic murmur of the mitral valve prolapse becomes a full systolic murmur, and other murmurs are weakened.
5 exercise, often makes the organic heart murmur significantly enhanced, the loudness of the functional murmur does not change much.
Diagnosis
Differential diagnosis
Systolic reflux murmur: It is the noise generated by the blood flowing back from the high pressure heart chamber through the abnormal passage to the low pressure heart chamber, also known as reflow murmur. The characteristic of the heart sound map is that the noise is consistent or increasing or decreasing. It starts after S1 and often covers S1; it lasts longer, and it takes more systole and has higher frequency. The murmur of the mitral insufficiency (most loud outside the apex and apical area, or to the lower left scapula) occurs early in the contraction, or most of the systole. The intensity is above 2 to 3, the pitch is high, rough, boasting or musical, and there are many forms on the heart sound map. Ventricular septal defect murmur is most loud between the 3 to 4 ribs on the left sternal border.
Diastolic qi murmur: a type of heart murmur. Heart murmur refers to the abnormal sound produced by the vibration of the wall, valve or blood vessel caused by end-flow of blood in the heart or blood vessels in addition to heart sounds and extra heart sounds. Normal blood flow is laminar, no sound is emitted, when blood flow is accelerated, abnormal blood flow channel or blood flow diameter abnormality and blood viscosity change can make laminar flow into turbulence, or vortex to impact heart wall, large blood vessels Walls, valves, chordae, etc. vibrate and produce noise at the corresponding parts.
Systolic murmur: It is the most common murmur in the clinic. It can be functional or organic. It is more common in function and is one of the heart murmurs. Heart murmur refers to the abnormal sound produced by the vibration of the wall, valve or blood vessel wall caused by turbulence in the heart or blood vessels during heart contraction or extra heart sounds. When the mitral regurgitation is incomplete, During the left ventricular systole, blood flows back from the left ventricle to the left atrium and produces a murmur, and the resulting systolic murmur is transmitted to the left underarm. Any factor that increases the pressure gradient between the left ventricle and the left systole during systole can be enhanced with noise. When inhaling, the pressure in the thoracic cavity decreases (less than atmospheric pressure, the amount of blood pumped into the pulmonary circulation by the right ventricle increases, the left ventricular filling volume also decreases, and the pressure in the left ventricle in the left ventricle is relatively decreased during the systole. The amount of reflux blood is relatively reduced, and the noise will be weakened. When exhaling, the pressure in the chest cavity is increased (greater than atmospheric pressure), the blood volume of the right ventricle pumping into the pulmonary circulation is increased, and the left ventricular filling volume is also increased, and is affected by the chest pressure. The systolic left ventricular left room pressure gradient will increase relatively, the amount of reflux blood will increase, and the noise will increase.
Heart murmur: refers to a kind of non-heart sounding noise sound with different frequencies, different intensities and long durations other than heart sounds and additional heart sounds. It can be separated or continuous with the heart sound, or it can completely cover the heart sound. Heart murmurs can be seen in healthy people and more in patients with cardiovascular disease. Some murmurs are the main basis for the diagnosis of heart disease, such as the mid-diastolic phase with pre-systolic rumbling murmur in the apical region, which can be diagnosed as mitral stenosis.
The second intercostal continuum of the left sternal border is a loud, murmur with continuous tremor, often suggesting the presence of patent ductus arteriosus, and cardiac occlusion plays an extremely important role in the diagnosis of heart disease.
The auxiliary measures for sound diagnosis include:
1 Breathing, most of the systolic and diastolic murmurs from the right heart are enhanced when inhaling, and the opposite is true when exhaling. Therefore, breathing can distinguish the aortic valve from the pulmonary valve, mitral valve and tricuspid regurgitation.
2 position, supine to make the tricuspid regurgitation, the murmur of the semilunar stenosis is enhanced, and the murmur of the aortic stenosis is weakened. In the left lateral position, especially in the first 6 to 10 cardiac cycles, the murmur of the mitral stenosis is enhanced. Rapid squatting can increase venous return and raise blood pressure, which can weaken or disappear the aortic subvalvular stenosis and mitral valve prolapse. The right to left shunt of Fallot's quadruple is reduced, and the funnel is narrow. Increased blood flow, prolonged noise increase.
3 The length of the cardiac cycle, after the long period of atrial fibrillation or the premature contraction compensation interval, the systolic jet murmur of the left and right outflow tract obstruction is enhanced, while the full systolic reflux murmur from the mitral valve and ventricular septum is absent. Variety.
4 sustained Valsalva's movement (the glottis closed forcibly exhaled to increase intrathoracic pressure, affecting venous blood return to the blood), reducing venous return, blood pressure, ventricular volume reduction, and aortic stenosis The murmur is enhanced, and the late systolic murmur of the mitral valve prolapse becomes a full systolic murmur, and other murmurs are weakened.
5 exercise, often makes the organic heart murmur significantly enhanced, the loudness of the functional murmur does not change much.
