systolic ejection murmurs chapter 14 are g. talking, md, facc instructor patricia l. thomas, mba,...
TRANSCRIPT
![Page 1: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/1.jpg)
Systolic Ejection MurmursChapter 14
Are G. Talking, MD, FACC
Instructor
Patricia L. Thomas, MBA, RCIS
![Page 2: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/2.jpg)
Outline
• Outflow Tracts• Inflow Tracts• Inter-Ventricular Flow• Ejection Murmur• Classification of
Ejection• Aortic Stenosis• Bicuspid Aortic Valve
• Tetralogy of Fallot• Dilatation of the
Proximal Pulmonary• Pulmonary Arterial
Narrowing• Coarctation of the
Aorta• Musical Murmurs
![Page 3: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/3.jpg)
Introduction
• Levine stated, “Systolic noise with a duration longer than a heart sound.”
• Result of turbulent blood flow across outflow tracts, ejection murmurs,inflow tract, and from ventricle to ventricle
![Page 4: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/4.jpg)
Outflow Tracts/ Ejection Pathways
• Left outflow tract– Left ventricle– Aortic valve– Aortic root– Ascending Aorta
• Right outflow tract– Right ventricle– Pulmonary Valve– Main Pulmonary
Artery
![Page 5: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/5.jpg)
Causes of Abnormalities of Flow
• Forward flow across normal outflow tracts• Forward flow across stenosed aortic or
pulmonic outflow tracts• High flow across normal right or left
ventricular outflow tracts• High flow across a regurgitant aortic or
pulmonic valve without significant stenosis• Forward flow into a dilated great vessel
![Page 6: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/6.jpg)
Inflow Tracts
• The inflow tracts of the heart are the chambers that are open to tack other during diastolic filling. – Mitral valve is part of the left inflow tract– Tricuspid valve is part of the right inflow tract
• Abnormalities are insufficiency/regurgitant related: rheumatic valvular disease, mitral valve prolapse, or papillary muscle dysfunction
![Page 7: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/7.jpg)
Inter-Ventricular Flow
• Small VSD results in turbulent blood flow from ventricular to ventricle
![Page 8: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/8.jpg)
Ejection Murmur
• Mixed frequencies and is moderate-to-marked crescendo-decrescendo
• Caused by forward flow across the left or right outflow
• Aortic stenosis & pulmonic stenosis
![Page 9: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/9.jpg)
Classification of Ejection Murmurs• Early Systolic Ejection Murmur
– Commonly heard in a small VSD without pulmonary hypertension, large VSD with pulmonary hypertension, septal perforation resulting from MI, acute severe mitral regurgitation
• Mid-systolic Ejection Murmur– Long and is loudest in mid-systolic with the sound of S2
clearly audible & implies significant aortic or pulmonic outflow tract obstruction, TOF, dilatation of he proximal pulmonary artery or ASD
![Page 10: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/10.jpg)
Aortic Stenosis• Murmur is harsh, rough, & grunting• Degrees of Obstruction
– Mild- softer, shorter & earlier-peaking systolic murmur– Severe-louder, longer, & late-peaking murmur
• Causes– Result of congenital aortic valve disease, rheumatic fever
(aortic & mitral valve involved), or degenerative calcification in elderly patients
• Listen with the diaphragm of the stethoscope for maximal intensity at the second right intercostal space; listen at the apex & over the precordium, both clavicles, both carotids, & suprasternal notch
![Page 11: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/11.jpg)
![Page 12: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/12.jpg)
![Page 13: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/13.jpg)
![Page 14: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/14.jpg)
![Page 15: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/15.jpg)
Pulmonic Valve Stenosis• Harsh systolic murmur,wide splitting of S2
• Loudest in the 2nd & 3rd interspaces along the left sternal border (pulmonic area)
• Palpable Thrill felt directed toward the left neck or clavicle
• Murmur peaks in mid-systole with maximal ejection & produces a diamond shape on the phono.
• Heard during expiration• Ejection sound heard over the pulmonary area• Sound caused by doming & abrupt arrest in motion of
the stenotic PV
![Page 16: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/16.jpg)
![Page 17: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/17.jpg)
![Page 18: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/18.jpg)
Tetralogy of Fallot
• Described by Fallot in 1888• VSD, Pulmonic Stenosis, Dextroposition of the
aorta & RV hypertrophy• PS results of a fibromuscular ring below the PV in
the RV out flow tract-infundibular • More severe the obstruction, the more blood is
shunted RT to LT the VSD• Systolic thrill pulmonic with grade IV murmur
![Page 19: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/19.jpg)
![Page 20: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/20.jpg)
![Page 21: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/21.jpg)
Coarctation of the Aorta
• Grade II or III murmur
• Heard posteriorly & over base of the heart
• Hypertension in the arms, but not in the legs
• Decreased or absent femoral arterial pulsation
![Page 22: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/22.jpg)
![Page 23: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/23.jpg)
Musical Murmurs• Caused by vibrating structure enve in the the absence of
flow turbulence• Musical systolic murmurs
– Cooing of a dove
– Buzzing of a saw
– Spinning of a top
– Whistling
– Systolic whoop
– Precordial honk
• Mitral valve prolapse can assume such a noise
![Page 24: Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS](https://reader035.vdocuments.site/reader035/viewer/2022062621/551c49d4550346b1458b4988/html5/thumbnails/24.jpg)
THE END OF
CHAPTER 14
Tilkian, Ara MD Understanding Heart Sounds and Murmurs,
Fourth Edition, W.B. Sunders Company. 2002, pp. 154-178