Notes on Heart Sounds and Murmurs
Rahul's Noteblog
Notes on Cardiology
Notes on Heart Sounds and Murmurs
| Heart Sound | Cause |
| S4 Heart Sound: | Stiff and hypertrophied ventricles; hypertrophic cardiomyopathy; ventricular hypertrophy due to hypertension; immediately precedes S1 heart sound; ventricular gallop; left-sided S4 is heard best in left lateral decubitus position while expiring; right-sided S4 is heard best in the lower left sternal border while the patient lies in supine position; may be normal in children and young adults. |
| S3 Heart Sound: | Congestive Heart Failure; dilated cardiomyopathy; volume-overloaded right ventricle; heard best in left lateral decubitus position while expiring. |
| Harsh holosystolic murmur heard over tricuspid area (left lower sternal border): | Ventricular Septal Defect. |
| ST elevation + T inversion + unrecognizable QRS complexes: | Ventricular fibrillation. |
| Diastolic murmur in upper left sternal border (precordium); early diastolic decrescendo murmur radiating to the apex; early high-pitched blowing diastolic murmur; diastolic decrescendo murmur at the right upper sternal border; wide pulse pressure; head bobbing with each heart beat; bounding pulse; often accompanied by diastolic "blowing" murmur (i.e., an aortic regurgitation murmur): | Aortic regurgitation/insufficiency. |
| Midsystolic click followed by late systolic murmur: | Mitral valve prolapse; loudest during valsalva maneuver. |
| Crescendo-decrescendo mid-systolic ejection murmur radiating to the neck; weak and late pulses; harsh systolic murmur; "diamond-shaped;" may be preceded by an opening click; pulsus parvus et tardus; paradoxical splitting of S2: | Aortic stenosis; may be due to age-related calcified aortic valve. Young adults with bicuspid aortic valve can also have this murmur. |
| Mid-systolic ejection murmur heard in pulmonic area; may be accompanied by wide fixed split S2; S1 may be a bit louder: | Atrial Septal Defect. |
| Diastolic decrescendo murmur radiating to the axilla; Systolic murmur that is apical and holo- or pan-systolic radiating to left axilla; high-pitched blowing holosystolic murmur: | Mitral regurgitation/insufficiency. |
| Loud S1 + diastolic murmur heard at apex; opening snap followed by delayed, rumbling late-diastolic murmur: | Mitral stenosis. |
| Crescendo-decrescendo murmur; harsh systolic murmur heard along left middle to upper sternal border: | Pulmonary valve stenosis. |
| High-pitched diastolic murmur: | Coarctation of the aorta. |
| Pulsus paradoxus: | Exaggeration of normal physiology; pericarditis (enlarged heart, but not as enlarged as in hypertrophic cardiomegaly); drop in systolic BP during inspiration; also heard in pericardial tamponade; may be due to bacterial infection. |
| Harsh systolic murmur in aortic area at right upper sternal border: | Hypertrophic obstructive cardiomyopathy; angina; cardiac ischemia. |
| Continuous machine-like murmur: | Patent ductus arteriosus. |
| Widely split fixed S2 + midsystolic ejection murmur over left upper sternal border: | Patent foramen ovale. |
| High-pitched blowing holosystolic murmur; heard at the lower left parasternal area; varies with respiration; becomes louder with inspiration; prominent jugular pulse: | Tricuspid regurgitation (could be due to Ebstein anomaly or IV drug abuse). |
| Diastolic murmur that increases with inspiration: | Tricuspid stenosis (rare murmur). |
Additional Reading:
Basic Cardiology
1. Electrical Activity of the Heart
2. Heart Muscle Mechanics
3. Heart Sounds and Murmurs
Related Topics
1. Thorax Anatomy
2. Vascular Disorders
3. Heart Disorders
4. Histology of the Cardiovascular System
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Page accessed on: July 29, 2010, 11:47 am.