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Heart sounds and murmurs

Prof Anura Weerasinghe

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Objectives Heart sounds (including murmurs) & their

genesis

Correlation of heart sounds with cardiac

events

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enesis Heart sounds

!"udden changes in the rate of flow createvibrations which can be heard#

$urmurs

!%ue to turbulent blood flow ruits

!noise heard over blood vessels

'hrill!ibration as erceived b* the sense of touch

Rene Laennecinvented the stethoscoe#

(+,-+ ! +-./)

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Heart sounds Closing of the valves is associated with audible

sounds

0o audible sounds occur when valves oen

'he first heart sound

!associated with closure of the atrioventricular valves

'he second heart sound

!associated with closure of the semilunar valves

+st 111s*stole111 .nd111%iastole 111 +st

lub dub lub

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"litting of heart sounds 'he mitral valve closes slightl* before the

tricusid valve# ut the slitting of the firstheart sound is difficult to be detected b*

auscultation#

0ormall* ulmonar* valve closure alwa*sfollows aortic valve closure and the slitting

is widest during insiration# "litting can be

heard with the stethoscoe as the* are high1

itched sounds#

Pulmonar* valve closure is normall* heard onl* in ulmonar*

area and a short distance down the left sternal edge#

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u*ton .2/

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3rdand 2thheart sounds

3rdheart sound!heard about +43 of the wa* through diastole

!associated with raid ventricular filling!ma* be h*siological in health* *oung eole

2thheart sound!associated with atrial contraction

'hose sound are detected b*honocardiograh*

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$urmurs as a result of diseases

of the valves 0arrowed (stenosis)

!lood flow through it in the normal direction

roduces the murmur

5ncometent (insufficienc*)

!lood flow bac6ward through it roduces the

murmur (regurgitation)

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Heart murmurs

alve Abnormalit* 'iming ofmurmur

Aortic orulmonar*

"tenosis "*stolic

5nsufficienc* %iastolic

$itral ortricusid

"tenosis %iastolic

5nsufficienc* s*stolic

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Congenital heart diseases

Ac*anotic!entricular setal defect

Pan s*stolic murmur over the recordium

!Atrial setal defect

7jection s*stolic murmur over the PA due to

increased blood floor through the normal ulmonar*

valve

!Patent ductus arteriosus Continuous murmur

C*anotic

!8allot9s tetrolog*

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u*ton .:;

Patent %uctus Arteriosus

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u*ton .:+

8allot9s tetralog* "%

P" Overrding of the aorta

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u*ton .2/

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Objectives Heart sounds (including murmurs) & their

genesis

Correlation of heart sounds with cardiac

events