This document provides an overview of heart sounds and murmurs. It discusses the basics of heart sounds and where they are most audible. It describes different types of cardiovascular system anomalies and abnormalities, including structural defects, functional defects, and positional defects. It then focuses on innocent murmurs versus pathological murmurs, describing the characteristics of each. It provides details on specific murmurs associated with conditions like aortic stenosis, mitral regurgitation, aortic regurgitation, and mitral stenosis. It also briefly discusses continuous murmurs.

1. Heart sounds.
Valmiki Seecheran.
Year V MBBS.

2. CVS Anomalies.
• Structural heart defects.
– Cyanotic, acyanotic.
• Functional heart defects.
– Cardiac arrhythmias.
• Positional heart defects.
– Dextrocardia.

3. Basics.
• When does it occur?
– Systole.
– Diastole.
• Where is it most audible?
– Aortic.
– Pulmonary.
– Tricuspid.
– Mitral.
• Diastolic murmurs.
– AR – early diastole.
– MS – mid to late diastole.
• Systolic murmurs.
– AS – ejection.
– MR – holosystolic.
– MVP – late systole.

7. Murmurs
• Types.
– Innocent.
– Pathological.
• Turbulence in blood flow at or near a valve.
– May be present without any pathology.
• Shunt murmur
– Abnormal communication within the heart.

8. Innocent murmurs.
• Known as flow, benign, non pathologic,
functional, physiological.
• No structural defects.
• No hemodynamic abnormalities
• Prominent in high output states (fever,
dehydration, anxiety, infections).

9. Character of (IM)
• Systolic, soft, grade II.
• No thrill.
• Intensity variable – changes with posture.
• Normal.
– Pulse.
– S2.
– CXR & ECG.

10. Pathological murmurs.
• Associated with structural abnormalities.
• Characteristics
– Grade III or >.
– Thrills.
– Pansystolic/ Diastolic.
– Abnormal
• Pulse.
• ECG, CXR.

11. Systolic murmurs.
• Holosystolic/ Pansystolic.
– Mitral regurgitation.
– Tricuspid regurgitation.
– Ventricular Septal defect.
• Ejection systolic (Mid-systolic).
– Innocent murmur.
– Aortic sclerosis.
– Aortic Stenosis/ Pulmonary stenosis.
• Late systolic.
– Mitral valve prolapse.
– Tricuspid valve prolapse.

12. Aortic stenosis.
• Mid-diastolic.
• Loudest in aortic area, radiates along carotid
arteries.
• Intensity varies with cardiac output.
• A2 decreases as stenosis worsens.
• Similar conditions that mimic AS.
– Aortic sclerosis.
– Dilated aorta.
– Bicuspid aortic valve.
– Increased flow.

13. Mitral regurgitation.
• Pansystolic.
• Loudest at left ventricular apex.
• Radiates to the base of heart OR to axilla and
back.
• Systolic thrill, a soft S3 and diastolic rumbing
(left lateral decubitus).
• Similar conditions that mimic MR.
– Tricuspid regurgitation.
– VSD.

14. Diastolic murmurs.
• Early diastolic.
– Aortic regurgitation.
– Pulmonary regurgitation.
• Mid diastolic.
– Mitral stenosis. – (Late Diastolic).
– Tricuspid stenosis. – (Late Diastolic).
– Increased flow across AV valve.
– Atrial myoxma.
– Austin Flint/ Carey- Coombs.

15. Aortic regurgitation.
• Early diastolic.
• Heard at 2nd ICS at left sternal edge.
• High pitched, decrescendo.
• Radiates to LSB (valvular pathology) OR RSE
(aortic pathology).
• Associated murmurs.
– Mid-systolic.
– Pulmonary regurgitation.
– Austin Flint.

16. Mitral stenosis.
• Mid-diastolic – rapid ventricular filling.
• Presystolic – atrial contraction – disappears in
atrial fibrillation.
• Low pitched.
• Best heard over apex.
• Little or no radiation.
• Opening snap, S1 accentuated.

17. Continuous murmurs.
• PDA.
• Aortic pulmonary window.
• Arteriovenous fistula.
• Venous hum.

18. Continuous murmurs.
• Begin in systole. Peak near S2. Continue into diastole.
• Mammary souffle.
– Audible during late 3rd trimester.
– Augment arterial flow through engorged breasts.
• Pericardial friction rub.
– Scratchy, scraping quality.
• PDA.
– Harsh, machinery-like noise.
• Venous hum.
– Audible in children, muted by compression over IJV.

19. Thank you.