Heart murmur – when, where, what?

When assessing your heart, you might notice additional heart sounds or heart murmurs once you auscultate the chest. Generally, murmurs may be distinguished from additional sounds akin to S3 or S4 as a consequence of their longer duration, but there may be way more to assessing murmurs and understanding their causes. The best solution to learn is to hearken to whispers at any time when possible! Let’s have a look at among the basics.

Characteristics of murmurs

The timing of the murmur’s onset is set by when the murmur is a heart murmur within the cardiac cycle. Systolic murmurs are heard between S1 and S2; diastolic murmurs are heard between S2 and S1. They may be further characterised by how long they “take” to contract or chill out. A continuous murmur begins in systole and continues in diastole without interruption.

Various grading systems are used to explain the intensity or loudness of murmurs; a six-point scale is used to evaluate systolic murmurs, and a four-point scale is used to evaluate diastolic murmurs. Generally, the rating is expressed as a fraction, with the numerator representing the intensity at its loudest point and the denominator being 4 or 6, depending on the size used.

The intensity of the murmur could also be decreased as a consequence of obesity, emphysema, and pericardial effusion.

The shape or configuration of a murmur refers to its intensity over time. is used to explain sounds that worsen or louder. refers to those who soothe or reduce intensity. implies that the murmur increases after which decreases. means constant intensity.

When describing the situation of a murmur, it’s important to discover the place where the murmur is best heard, which is generally where it comes from. When fascinated with the radiance of a murmur, ask, “Where else can you hear the murmur?” In some cases, it could possibly be heard above the left shoulder blade or within the armpit.

Murmurs may be described as high, medium and low. The quality may be described as blowing, rough, scratchy, rumbling or musical.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and history taking (thirteenth ed.). Wolters Kluwer Health: Philadelphia.

Meyer, T. (2020, February 4). Auscultation of heart murmurs in adults. https://www.uptodate.com/contents/auscultation-of-cardiac-murmurs-in-adults

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