Heart murmurs Organic and fuctional murmurs

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HEART MURMURS
Minel Aşcıoğlu
220i-2a
Clinical Skills

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HEART MURMURS:
 Phenomena, appearing during heart activity in
pathological states, are called heart murmurs
 HEART MURMUR CLASSIFICATION:
 Intracardial
 — Organic
 — Functional

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 Extracardial
 — Friction sound of pericardium
 — Pericardium - plevral friction sound
 — In the result of stenosis of vessels
 — In the result of expanding of vessels

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REASONS OF APPEARANCE OF
MURMURS
 Narrowing or expansion of vessels
 Increasing of blood flow speed
 Diminishing of blood density

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Murmurs, encountered most frequently:
 Aortic stenosis (AS)- systolic
 Insufficiency of mitral valve (Ml) - systolic
 Insufficiency of aorta valve (Al) - diastolic
 Mitral stenosis (MS) - diastolic

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METHODS IMPROVE THE AUDIBILITY OF
MURMURS
 Noises in the right side of heart strengthen when breathing
 When squeesing a fist during mitral insufficiency the murmur
strengthens
 In hypertrophic KMP – in Valsalva test and squat position –
murmur strengthens
 On the left side noise phenomenon in left ventricules is
heard well
 Left ventriculi comes close to thorax
 Sounds 3 and 4 are heard well by stethoscope

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 Murmur is heard well in mitral stenosis
 When bending forward and breathing out, the noises of aorta valve
are heard well
 Using of phonendoscope is recommended
 In genu-cubital pose, prolapsing of mitral valve, systolic murmur is
heard well

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MITRAL REGURGITATION
 Holosystolic, diminishing murmur in apex
 Loudest at the apex; also often heard at the sternal edge; but rarely in the aortic area
 Irradiation towards axilla
 The 1%t sound weakens
 Organic
 — rheumatism
 Functional
 — prolapse
 — anaemia
 — thyrotoxicosis

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MITRAL STENOSIS
 In point 1
 Diminishing-increasing diastolic murmur
 Slow-pitched rumbling’
 Quail’s rhythm
 Organic- rheumatism
 Functional- Flint’s Kumb’s murmurs

16. z AORTAL STENOSIS
 Ejection systolic murmur in the 2nd point
 Loudest over the second right intercostals space,
but often audible over the whole precordium
 Radiates towards the neck
 Rough (‘harsh’) often described like as a saw going
through wood
 Pulse usually regular; may be slow- rising
 Blood pressure - reduced pulse pressure
 Character - Increasing-diminishing

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 Apex beat - 'heaving’
 Trill - often present
 Quiet aortic second heart sound; ejection
click may be audible
 Organic - rheumatism, atherosclerosis,
aorta coarctation
 Functional – anaemia , high temperature,
thyrotoxicosis, pregnancy

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AORTAL REGURGITATION
 Early, diminishing diastolic murmur in the 2nd and
the 5th points
 Right or left intercostals space 2-4
 Usually quiet, ‘blowing’, decresendo
 2nd sound weakens

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 Pulse collapsing
 Radiated to apex, of mixing up of mitral
stenosis
 Organic-rheumatism, sclerosis, bacterial
endocarditis
 Functional - dilatation of aorta

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DIFFERENCE BETWEEN FUNCTIONAL
AND ORGANIC MURMURS
 Functional murmurs are systolic
 It is not constant, changes due to the state of body and breathing
 Unstable, short
 Doesn't cause irradiation
 Soft and blowing
 There are no hypertrophia and dilation in the heart

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