Difference between revisions of "Heart Murmurs"

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{{OpenPagesTop}}
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===Description===
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== Introduction==
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On auscultation, heart murmurs are sounds that signify abnormal turbulent blood flow in the heart or surrounding blood vessels.
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*On auscultation, heart murmurs are sounds that signify abnormal turbulent blood flow in the heart or surrounding blood vessels.
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<br>
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'''Murmurs can arise from any of the following conditions:'''
 
'''Murmurs can arise from any of the following conditions:'''
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<br>
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1. Increased Blood Volume
 
1. Increased Blood Volume
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<br>
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2. Increased Blood Flow Velocity
 
2. Increased Blood Flow Velocity
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<br>
+
 
 
3. Valve Regurgitation
 
3. Valve Regurgitation
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<br>
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4. Decreased Blood Viscosity
 
4. Decreased Blood Viscosity
  
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== Types of Heart Murmurs ==
 
  
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===1. Systolic Heart Murmurs===
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===Types of Heart Murmurs===
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This is the most common type of murmur among small animal patients and occurs during systole.  
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====1. Systolic Heart Murmurs====
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*Most common type of murmur among small animal patients
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 +
*Occur during systole
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 +
 
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=====Functional Murmurs=====
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(Occur without a pathological condition involved)
 +
 
 +
-Innocent Murmurs (e.g. young animals with temporary murmurs)
 +
 
 +
-Physiologic/Flow Murmurs (e.g. athletic animals especially thoroughbred horses; conditions such as anaemia, fever, peripheral arteriovenous fistula)
 +
 
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*Aortic flow murmurs are the most common in normal young fit thoroughbred horses
 +
 
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*Valve regurgitations in horses can be functional or pathological (Endocardiosis is the most common form of older equine valve pathology)
 +
 
 +
 
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=====Pathological Murmurs=====
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-Atrioventricular valve insufficiency
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-Semilunar valve stenosis
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-Cardiac shunting (e.g. PDA, VSD)
 +
 
 +
 
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====2. Diastolic Heart Murmurs====
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*Uncommon in small animals
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*Occurs during diastole
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 +
 
 +
=====Functional Murmurs=====
 +
(Occur without a pathological condition involved)
 +
 
 +
-Physiologic/Flow Murmurs (e.g. athletic animals especially thoroughbred horses)
 +
 
 +
*Ventricular (mitral and tricuspid) flow murmurs are less common in young fit thoroughbred horses compared with aortic flow murmurs, but their presence can still be seen in normal horses.
 +
 
 +
 
 +
=====Pathological Murmurs=====
 +
 
 +
-Atrioventricular valve stenosis
 +
 
 +
-Semilunar valve insufficiency
 +
 
 +
-Cardiac shunting (e.g. PDA)
 +
 
 +
 
  
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====Functional Murmurs====
 
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(Occur without a pathological condition involved).
 
  
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These include:
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====3. Continuous Heart Murmurs====
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:''''Innocent Murmurs'''' - e.g. young animals with temporary murmurs
 
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:'''Physiologic/Flow Murmurs''' - e.g. athletic animals especially thoroughbred horses; conditions such as [[:Category:Anaemia|anaemia]], fever, peripheral [[Arteriovenous Fistula|arteriovenous fistula]]
 
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:'''Aortic flow murmurs''' - these are the most common in young animals, particularly young fit thoroughbred horses.
 
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<br>
 
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Valve regurgitations in horses can be functional or pathological. ([[Endocardiosis]] is the most common form of older equine valve pathology.)
 
  
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====Pathological Murmurs====
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*Also called machinery murmurs
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Include atrioventricular valve insufficiency, semilunar valve stenosis and cardiac shunting (e.g. [[Patent Ductus Arteriosus|PDA]], [[Ventricular Septal Defect|VSD]]).
 
  
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===2. Diastolic Heart Murmurs===
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*Occur continuously throughout systole and diastole
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These are uncommon in small animals and they occur during diastole.
 
  
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====Functional Murmurs====
 
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(Occur without a pathological condition involved).
 
−
These include '''Physiologic/Flow Murmurs''' (e.g. athletic animals especially thoroughbred horses) and '''Ventricular''' (mitral and tricuspid) flow murmurs, which are less common in young fit thoroughbred horses compared with aortic flow murmurs, but their presence can still be seen in normal horses.
 
  
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====Pathological Murmurs====
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=====Pathological Murmurs=====
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Include atrioventricular valve stenosis, semilunar valve insufficiency and cardiac shunting (e.g. PDA).
 
  
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===3. Continuous Heart Murmurs===
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-Cardiac shunting (e.g. PDA)
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Are also called machinery murmurs and occur continuously throughout systole and diastole.
 
  
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====Pathological Murmurs====
 
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These can occur in cardiac shunting and is characteristic for a PDA.
 
  
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==Description of Heart Murmurs==
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=====Description of Heart Murmurs=====
  
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1. '''Timing/Duration''' (Systolic, Diastolic, Continuous)
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1. Timing/Duration (Systolic, Diastolic, Continuous)
  
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2. '''Location''' (Point of Maximal Intensity; Left Side: Heart Base (Semilunar Valves), Heart Apex (Mitral Valve); Right Side: Tricuspid Valve)  
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2. Location (Point of Maximal Intensity; Left Side: Heart Base (Semilunar Valves), Heart Apex (Mitral Valve); Right Side: Tricuspid Valve)  
  
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3. '''Intensity''' (Grading of Heart Murmur is on a scale 1-6)
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3. Intensity (Grading of Heart Murmur is on a scale 1-6)
  
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4. '''Shape '''(Description from phonocardiogram:e.g. Holosystolic, Crescendo-decrescendo, Systolic decrescendo, Diastolic decrescendo, Continuous aka Machinery)
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4. Shape (Description from phonocardiogram:e.g. Holosystolic, Crescendo-decrescendo, Systolic decrescendo, Diastolic decrescendo, Continuous aka Machinery)
  
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5.''' Sound''' (Quality & Pitch: High Pitch usually indicates ejection murmurs; Low Pitch usually indicates regurgitant flow murmurs)
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5. Sound (Quality & Pitch: High Pitch usually indicates ejection murmurs; Low Pitch usually indicates regurgitant flow murmurs)
  
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6.''' Radiation '''(Description based on how far the murmur sound spreads from its point of maximal intensity. e.g. Aortic murmurs radiate up carotid arteries)
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6. Radiation (Description based on how far the murmur sound spreads from its point of maximal intensity. e.g. Aortic murmurs=radiate up carotid arteries)
  
  
 
===Heart Murmur Grading Scale===
 
===Heart Murmur Grading Scale===
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To listen to gradings and examples of canine cardiac murmurs visit [http://www.tiho-hannover.de/de/studium-lehre/el/lernmedien/heartsound-library/ the heartsound library].
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{| style="width:75%; height:200px" border="1"
 
{| style="width:75%; height:200px" border="1"
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|-  
 
|-  
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| <center>I.</center>
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| I.
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| Barely audible (need ideal conditions to hear)
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| Barely audible (Need ideal conditions to hear)
  
 
|-
 
|-
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|<center>II.</center>
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|II.
 
| Clearly audible at point of maximal intensity  
 
| Clearly audible at point of maximal intensity  
  
 
|-
 
|-
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|<center>III.</center>
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|III.
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| Clearly audible (as loud as S1 & S2; +/- radiation)
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| Clearly audible (As loud as S1 & S2; +/- Radiation)
  
 
|-
 
|-
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|<center>IV.</center>
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|IV.
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| Loud (louder than S1 & S2; - precordial thrill; radiation over thorax)  
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| Loud (Louder than S1 & S2; - precordial thrill; Radiation over thorax)  
  
 
|-
 
|-
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|<center>V.</center>
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|V.
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| Loud (louder than S1 & S2; + precordial thrill)
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| Loud (Louder than S1 & S2; + precordial thrill)
  
 
|-
 
|-
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|<center> VI.</center>
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| VI.
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| Very loud (audible with stethoscope lifted off chest; + precordial thrill)
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| Very Loud (Audible with stethoscope lifted off chest; + precordial thrill)
 
|-
 
|-
 
|}
 
|}
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[[Category:Cardiovascular_System_-_Pathology]][[Category:To_Do_-_Cardiovascular]]
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[[Category:Cardiac Diseases - Dog]]
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{{review}}
 
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{{OpenPages}}
 
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[[Category:Cardiovascular_System_-_Pathology]][[Category:Expert_Review]]
 
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[[Category:Cardiac Diseases - Dog]][[Category:Cardiac Diseases - Cat]][[Category:Cardiac Diseases - Horse]][[Category:Cardiac Diseases - Cattle]]
 
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[[Category:Cardiac Diseases - Pig]]
 
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[[Category:Cardiology Section]]
 

Revision as of 22:47, 16 December 2010

Description

  • On auscultation, heart murmurs are sounds that signify abnormal turbulent blood flow in the heart or surrounding blood vessels.


Murmurs can arise from any of the following conditions:

1. Increased Blood Volume

2. Increased Blood Flow Velocity

3. Valve Regurgitation

4. Decreased Blood Viscosity


Types of Heart Murmurs

1. Systolic Heart Murmurs

  • Most common type of murmur among small animal patients
  • Occur during systole


Functional Murmurs

(Occur without a pathological condition involved)

-Innocent Murmurs (e.g. young animals with temporary murmurs)

-Physiologic/Flow Murmurs (e.g. athletic animals especially thoroughbred horses; conditions such as anaemia, fever, peripheral arteriovenous fistula)

  • Aortic flow murmurs are the most common in normal young fit thoroughbred horses
  • Valve regurgitations in horses can be functional or pathological (Endocardiosis is the most common form of older equine valve pathology)


Pathological Murmurs

-Atrioventricular valve insufficiency

-Semilunar valve stenosis

-Cardiac shunting (e.g. PDA, VSD)


2. Diastolic Heart Murmurs

  • Uncommon in small animals
  • Occurs during diastole


Functional Murmurs

(Occur without a pathological condition involved)

-Physiologic/Flow Murmurs (e.g. athletic animals especially thoroughbred horses)

  • Ventricular (mitral and tricuspid) flow murmurs are less common in young fit thoroughbred horses compared with aortic flow murmurs, but their presence can still be seen in normal horses.


Pathological Murmurs

-Atrioventricular valve stenosis

-Semilunar valve insufficiency

-Cardiac shunting (e.g. PDA)



3. Continuous Heart Murmurs

  • Also called machinery murmurs
  • Occur continuously throughout systole and diastole


Pathological Murmurs

-Cardiac shunting (e.g. PDA)


Description of Heart Murmurs

1. Timing/Duration (Systolic, Diastolic, Continuous)

2. Location (Point of Maximal Intensity; Left Side: Heart Base (Semilunar Valves), Heart Apex (Mitral Valve); Right Side: Tricuspid Valve)

3. Intensity (Grading of Heart Murmur is on a scale 1-6)

4. Shape (Description from phonocardiogram:e.g. Holosystolic, Crescendo-decrescendo, Systolic decrescendo, Diastolic decrescendo, Continuous aka Machinery)

5. Sound (Quality & Pitch: High Pitch usually indicates ejection murmurs; Low Pitch usually indicates regurgitant flow murmurs)

6. Radiation (Description based on how far the murmur sound spreads from its point of maximal intensity. e.g. Aortic murmurs=radiate up carotid arteries)


Heart Murmur Grading Scale

Grade Description
I. Barely audible (Need ideal conditions to hear)
II. Clearly audible at point of maximal intensity
III. Clearly audible (As loud as S1 & S2; +/- Radiation)
IV. Loud (Louder than S1 & S2; - precordial thrill; Radiation over thorax)
V. Loud (Louder than S1 & S2; + precordial thrill)
VI. Very Loud (Audible with stethoscope lifted off chest; + precordial thrill)
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