Heart murmur: Difference between revisions
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===Systolic murmurs=== | ===Systolic murmurs=== | ||
A [[systematic review]] by the [http://jama.ama-assn.org/cgi/collection/rational_clinical_exam Rational Clinical Examination] addresses the diagnosis of systolic murmurs.<ref name="pmid9032164">{{cite journal |author=Etchells E, Bell C, Robb K |title=Does this patient have an abnormal systolic murmur? |journal=JAMA : the Journal of the American Medical Association |volume=277 |issue=7 |pages=564–71 |year=1997 |month=February |pmid=9032164 |doi= |url= |issn=}} [http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=9032164.ui Full text at OVID]</ref> | A [[systematic review]] by the [http://jama.ama-assn.org/cgi/collection/rational_clinical_exam Rational Clinical Examination] addresses the diagnosis of systolic murmurs.<ref name="pmid9032164">{{cite journal |author=Etchells E, Bell C, Robb K |title=Does this patient have an abnormal systolic murmur? |journal=JAMA : the Journal of the American Medical Association |volume=277 |issue=7 |pages=564–71 |year=1997 |month=February |pmid=9032164 |doi= |url= |issn=}} [http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=9032164.ui Full text at OVID]</ref> | ||
====Aortic stenosis==== | |||
A [[clinical prediction rule]] may help detecting moderate to severe aortic stenosis (defined as a valve area of 1.2 cm<sup>2</sup>or less, or a peak instantaneous gradient of 25 mm Hg or greater):<ref name="pmid9798818">{{cite journal |author=Etchells E, Glenns V, Shadowitz S, Bell C, Siu S |title=A bedside clinical prediction rule for detecting moderate or severe aortic stenosis |journal=Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine |volume=13 |issue=10 |pages=699–704 |year=1998 |month=October |pmid=9798818 |pmc=1500900 |doi= |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=1998&volume=13&issue=10&spage=699 |issn=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=citizendium&pubmedid=9798818 PubMed Central]</ref> | |||
* If the murmur does not radiate to the right neck, moderate aortic stenosis was very unlikely | |||
* If the murmur has at least three of the following signs, moderate stenosis was likely: | |||
** slow carotid artery upstroke | |||
** reduced carotid artery volume | |||
** murmur loudest at the second right intercostal space | |||
** reduced intensity of the second heart sound | |||
===Diastolic murmurs=== | ===Diastolic murmurs=== | ||
Revision as of 02:58, 4 November 2008
In medicine, heart murmurs are the "heart sounds caused by vibrations resulting from the flow of blood through the heart. Heart murmurs can be examined by heart auscultation, and analyzed by their intensity (6 grades), duration, timing (systolic, diastolic, or continuous), location, transmission, and quality (musical, vibratory, blowing, etc)."[1]
Classification
Systolic murmurs
A systematic review by the Rational Clinical Examination addresses the diagnosis of systolic murmurs.[2]
Aortic stenosis
A clinical prediction rule may help detecting moderate to severe aortic stenosis (defined as a valve area of 1.2 cm2or less, or a peak instantaneous gradient of 25 mm Hg or greater):[3]
- If the murmur does not radiate to the right neck, moderate aortic stenosis was very unlikely
- If the murmur has at least three of the following signs, moderate stenosis was likely:
- slow carotid artery upstroke
- reduced carotid artery volume
- murmur loudest at the second right intercostal space
- reduced intensity of the second heart sound
Diastolic murmurs
Auscultation
Murmurs may be graded by their loudness:[4]
- Grade I - not heard immediately
- Grade II - heard immediately
- Grade III - hear immediately, but louder
- Grade IV - associated with palpable thrill
- Grade V - may be heard with stethoscope partially off the chest
- Grade VI - may be heard with stethoscope off the chest
References
- ↑ Anonymous (2024), Heart murmur (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Etchells E, Bell C, Robb K (February 1997). "Does this patient have an abnormal systolic murmur?". JAMA : the Journal of the American Medical Association 277 (7): 564–71. PMID 9032164. [e] Full text at OVID
- ↑ Etchells E, Glenns V, Shadowitz S, Bell C, Siu S (October 1998). "A bedside clinical prediction rule for detecting moderate or severe aortic stenosis". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 13 (10): 699–704. PMID 9798818. PMC 1500900. [e] PubMed Central
- ↑ McGee, Steven R. (2007). Evidence-Based Physical Diagnosis: Text with BONUS PocketConsult Handheld Software. Philadelphia: Saunders, 456. ISBN 1-4160-2898-6.
Bibliography
- McGee, Steven R. (2007). Evidence-Based Physical Diagnosis: Text with BONUS PocketConsult Handheld Software. Philadelphia: Saunders. ISBN 1-4160-2898-6.
- Drummond Rennie; David Simel (2008). THE RATIONAL CLINICAL EXAMINATION: EVIDENCE-BASED CLINICAL DIAGNOSIS (Jama & Archives Journals). McGraw-Hill Professional. ISBN 0-07-159030-7.