PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

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Heart MurmurPROBLEM BASED LEARNING (PBL)
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

2. What is heart murmur?
• A heart murmur is an extra or unusual sound heard due to
turbulent blood flow within the heart during a heartbeat .
• Normal heartbeats make a "lub-DUPP" or "lub-DUB" sound.
• Heart murmur sound like a whooshing or swishing noise.
• Doctors can hear these sounds and heart murmurs using a
stethoscope. (auscultation)

5. • Most murmurs are normal or harmless.
Normal murmurs are caused by the normal flow of
blood through the heart and large vessels near the
heart. The murmur may come and go over time.
Some things that can increase blood flow and cause
heart murmur to be heard include:
- Exercise
- Pregnancy
- Extreme anxiety
- Anemia
- Fever
- Hyperthyroidism

6. But some heart murmurs can signal an underlying heart problem.

7. Systolic Murmurs
• Ejection systolic murmurs: reach a peak midway
between 1st and 2nd heart sounds and don't run
into the 2nd heart sound. Usually maximal at the
upper sternal borders, and possible causes
include:
• Aortic stenosis. (most frequent)
• Pulmonary stenosis.
• Coarctation of the aorta: murmur is heard over
the back, particularly in the interscapular region.
• Hypertrophic obstructive cardiomyopathy.

8. • Pansystolic murmurs have uniform intensity
between 1st and 2nd heart sounds and merge
with the 2nd heart sound, which is therefore
not distinguishable. Those at the lower sternal
border are more likely to be of regurgitant
type due to:
• Ventricular septal defect.
• Atrial septal defect.
• Mitral or tricuspid regurgitation.

9. Diastolic murmurs
• Early diastolic murmurs: occur just after the
2nd heart sound. They are high-pitched and
easily missed.
• Causes include aortic valve regurgitation and
pulmonary valve regurgitation or with
pulmonary hypertension.
• Mid or late diastolic murmurs: are low-pitched
and occur at the lower sternal borders in
mitral stenosis or tricuspid stenosis.

10. Continous murmurs
• These murmurs are due to blood flow from a high
pressure chamber or vessel to a lower pressure
system.
• Patent ductus arteriosus. PDA is an abnormal
connection between the aorta and the
pulmonary artery, which normally should be
closed in infancy. Since aortic pressure is higher
than pulmonary pressure, a continuous murmur
occurs. This murmur is often described as a
machinery murmur, or Gibson's murmur