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Heart murmur

German: Herzgeräusche

1 Definition

Heart murmurs are pathological, meaning unhealthy current as well as valve generated sounds, originating from the heart. With that they differ from the normal physiological heart sounds.

2 Pathophysiology

The most common cause for heart murmurs are defects of a heart valve (so called heart valve defect) or the stenosis of the attached blood vessels, which gives rise to bruits because of altered haemodynamics.

3 Classification

Heart murmurs can be differentiated by their appearance during different cardiac actions. One distinguishes:

4 Characterization of heart murmurs

4.1 Intensity

In order to get a more accurate assessment of the loudness of the murmur the Levine scale, which ranges from 1 to 6, is used.

  • 1/6 – can only be heard with difficulty during auscultation
  • 2/6 – faint sound, but can always be heard using auscultation
  • 3/6 – loud, but without palpable thrill
  • 4/6 – loud sounds, with palpable thrill
  • 5/6 – sounds can be heard without directly placing the stethoscope on the body (i.e. with a finger placed in between)
  • 6/6 – sounds can be heard with the stethoscope lifted above the chest

4.2 Location

The location on the chest where a heart murmur has the maximum volume and the clearest sounds is normally referred to as the point of maximal impulse (PMI).

4.3 Transmission

Sometimes sounds that can be heard at the heart can also be perceived in other vessels or body areas. In that case, one refers to it as transmission. For example, the murmur of an aortic stenosis is transmitted to the common carotid artery.

4.4 Noise generation

The noise generation, in particular: increasing, decreasing or constant volume, is also considered for detailed documentations. Typical description are:

  • Crescendo – an initially faint murmur increases in volume
  • Decrescendo – an initially loud murmur decreases in volume
  • Rectangular or plateau – constant volume
  • Crescendo-decrescendo – volume increases to a maximum and then decreases again

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