Innocent Systolic Murmur Chapter 13

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Innocent Systolic MurmurChapter 13

• Are G. Talking, MD, FACC
• Instructor
• Patricia L. Thomas, MBA, RCIS

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Outline

• Characteristics of an Innocent Murmur
• Characteristics of a Pathological Murmur
• Where Systolic Murmurs May be Produced
• Classification
• Stills Vibratory Systolic Murmur
• Physiological Pulmonary Ejection Murmur
• Supraclavicular Arterial Bruit, Venous Hum
• Peripheral Pulmonary Stenosis of the Newborn
• Innocent Aortic Systolic Murmur
• Mammary Arterial Souffle
• Straight-Back Syndrome Pectus Excavatum

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Characteristic of An Innocent Murmur

• Short (early to mid-systolic, except for the
  venous hum
• Low to medium pitch
• Possibly a musical component
• Normal physiological splitting of S2
• Commonly found in children early teen year
• Isolated systolic murmurs in the elderly are
  common are frequently innocent

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Characteristics of A Pathological Murmur

• Six Cardinal Clinical Signs
• Holosystolic Murmur
• Harsh Murmur
• Abnormal heart sound
• Early or mid-systolic click
• Grade III murmur or greater
• Heard over the upper left sternal border

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Where Systolic Murmurs May Be Produced

• Connection of the jugular, subclavian,
  innominate veins to SVC (venonus hum
  supraclavicular spaces)
• Connection of RV to MPA (Pulmonary flow murmur
  left sternal border, 2nd 3rd intercostal spaces)
• Connection of the MPA to the RT LT PA branches
  (peripheral PS of the newborn upper sternal
  border)
• Connection of the LV to the AO (Stills murmur
  apex)
• Connection of the Aortic Arch to the
  brachiocephalic vessels (supra-clavicular
  arterial bruit supracalvicular fossa)

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Classification

• Five types of innocent murmurs heard in
  childhood
• Stills murmur or vibratory systolic murmur
• Physiological or functional pulmonary ejection
  murmur
• Supraclavicular arterial bruit
• Venous hum
• Peripheral Pulmonary stenosis of the newborn

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Stills Vibratory Systolic Murmur

• Peak incidence in children 3 to 7 years,
  disappears at puberty
• Musical, vibratory, low-frequency, early systolic
  ejection murmur
• George F. Stills in 1909
• A twanging sound
• Turbulence produced by the physiological
  narrowing of the LV outflow tract
• Listen with the bell of the stethoscope over the
  lower mid-precordium or left lower sternal border
  across to the apex

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Physiological Pulmonary Ejection Murmur

• Early systolic, crescendo-decrescendo,
  mid-frequency, grade II
• Decreases during inspiration when a child sits
• Turbulent flow at the origin of the RT LT
  pulmonary arteries
• Listen with the diaphragm of the stethoscope
  along the left sternal border in the 2nd to 3rd
  intercostal space in supine position
• Heard best during inspiration

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Supraclavicular Arterial Bruit

• Low to medium pitched, short, systolic,
  crescendo-decrescendo murmur
• Unaffected by respiration Grade II or Grade III
• Heard at any age mid-childhood in 30 to 40 of
  young adults
• Common in high-output conditions anemia
  anxiety prominent in trained athletes with slow
  heart rates high stroke volume
• Turbulence in the brachiocephalic or carotid
  arteries at their branching from the aorta
• Listen with the bell of the stethoscope over the
  supraclavicular fossa and over the sternomastoid
  muscle with patient sitting

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Venous Hum

• Blowing Continuous extracardiac murmur that is
  loudest during diastole
• Whining, roaring, or whirring intensity varies
  form faint to grade VI
• Louder under the inner edge of the right clavicle
  but extends form the supraclavicular area over
  the right internal jugular vein to the base of
  the heart
• Thrill is often present in children with venous
  hum
• Causes result form turbulent blood flow caused by
  two streams of blood entering the SVC
• Listen with the bell of the stethoscope in the
  right supraclavicular space

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Peripheral Pulmonary Stenosis of the Newborn

• Short mid-systolic ejection murmur of medium
  pitch intensity is best heard in the second
  intercostal space at the left sternal border
• Result of the turbulence caused when the MPA is
  bigger or dilated than its branches
• Heard in newborns and premature infants
• Listen with the bell of the stethoscope during
  systole at the upper left sternal border
  axillary areas

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Innocent Aortic Systolic Murmur

• Short, crescendo-decrescendo, low to medium pitch
• Children, systolic flow murmurs may be secondary
  to any condition with increased systemic cardiac
  output
• Listen with the bell of the stethoscope over the
  aortic area

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Mammary Arterial Souffle

• Described by Van Den Bergh in 1908
• A medium to high-pitched murmur, arising in
  systole possibly continuing into diastole
• Listen with the diaphragm of the stethoscope on
  the anterior chest wall over the breast

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Straight-Back Syndrome Pectus Excavatum

• Decrease of the anteroposterior diameter of the
  chest because of the loss of the normal degree of
  kyphosis of the upper thoracic spine,
  straight-back syndrome or because of the inward
  cavitation of the sternum at the anterior chest
  wall
• Pulmonary systolic ejection murmur
• Exaggerated inspiratory splitting of S2
• X-ray revealing displacement of the heart to the
  left, apparent cardiomegaly, pancake heart

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THE END OF CHAPTER 13

• Tilkian, Ara MD Understanding Heart Sounds and
  Murmurs,
• Fourth Edition, W.B. Sunders Company. 2002, pp.
  138-153