Systolic murmur

Introduction Systolic murmur is the most common murmur in the clinic. It can be functional or organic, and it is more common in function. It is one of the heart murmurs. Heart murmur refers to the abnormal sound produced by the vibration of the wall, valve or blood vessel wall caused by turbulence in the heart or blood vessels during heart contraction or extra heart sounds. When the mitral regurgitation is incomplete, During left ventricular systole, blood flows back from the left ventricle to the left atrium and produces murmurs, and the resulting systolic murmur is transmitted to the left iliac crest. Anything that increases the pressure gradient between the left ventricle and the left atrium during systole The factors can be enhanced by noise. When inhaling, the pressure in the thoracic cavity decreases (less than atmospheric pressure), the blood volume of the right ventricle pumped into the pulmonary circulation increases, the left ventricular filling volume also decreases, and is affected by the chest pressure, in the systolic phase. The pressure gradient in the left room of the room will decrease relatively, the amount of reflux will be relatively reduced, and the noise will be weakened. When exhaling, the chest pressure will increase (greater than atmospheric pressure), the blood volume of the right ventricle pumped into the pulmonary circulation will increase, and the left ventricular filling volume will also increase. Increased, and affected by chest pressure, the pressure gradient in the left ventricle of the left ventricle will increase relatively during the systole, the amount of reflux will increase, and the noise will increase.

Cause

1) apex: 1 Functionality: common in fever, anemia, hyperthyroidism, pregnancy, strenuous exercise, also seen in some healthy people in a quiet situation. The auscultation features a hair dryer, soft, short and weak (1/6 or 2/6), mostly in the middle of the contraction, and the limitation is not transmitted to other places. It may disappear after exercise or after removing the cause. 2 relativity: due to the enlargement of the left ventricle, the relative closure of the mitral valve is caused by dilated cardiomyopathy, hypertensive heart disease and so on. The characteristics of the auscultation are a murmur, which is softer, and the murmur can be attenuated after the left ventricular cavity is reduced. 3 organic: more common, mainly seen in rheumatic valvular disease mitral regurgitation, mitral valve prolapse, papillary muscle dysfunction. The auscultation is characterized by a full systolic murmur, which can cover the first heart sound, high-grade and rough, and the intensity is often 3/6 or above. It is transmitted to the left or lower left scapular region, weakened during inhalation, and exhaled. Strengthened, the left lateral position is more obvious. 4 conduction: the murmurs in other parts of the anterior region can also be transmitted to the apex, such as the systolic murmur of tricuspid regurgitation.

2) Aortic valve area: 1 organic: mainly seen in aortic stenosis. The auscultation features a jet or a blow-like murmur, a diamond shape, does not cover the first heart sound, is of rough nature, often accompanied by tremors, and the murmur is transmitted to the neck with A2 weakening. 2 relativity: mainly seen in aortic atherosclerosis, aortic dilation, hypertension and so on. The auscultation features a softer, murmur-like murmur, often accompanied by A2 hyperactivity.

3) Pulmonary valve area: 1 harmless: more common. Mostly found in healthy children and adolescents, the auscultation features a soft, weak, low-pitched, murmur-like murmur that is not transmitted, often below 2/6, apparently in the supine position, weakened or disappeared when sitting. 2 organic: rare, can be seen in congenital pulmonary stenosis. The noise is jetting, rough and loud, and the intensity is 3/6 or 3/6. It is rhomboid and is transmitted to the periphery and back, with tremor, P2 weakens and splits.

4) Tricuspid valve area: 1 relative: more common. Due to the enlargement of the right ventricular cavity, the tricuspid valve is relatively closed. The auscultation features a hairy sample, which is softer, enhanced when inhaling, and weakened at the end of expiration. It can be transmitted to the apical region, and attention should be paid to the differentiation of the mitral regurgitation. 2 organic: rarely seen, the characteristics of murmur and mitral regurgitation are similar.

5) Other parts: In the case of ventricular septal defect, the systolic murmur of the third and fourth ribs on the left sternal border can be heard and the loud and loud systolic murmur, the loudness is often above 3/6, and can be transmitted to other parts of the anterior region. With tremors.

an examination

Related inspection

ECG CT examination

Most patients have no obvious symptoms, and the symptoms appear intermittent, repetitive and transient. Common symptoms are:

1. Chest pain: the incidence rate is 60% to 70%, located in the anterior region, can be dull pain, sharp pain or knife-like pain, usually mild, lasting for several minutes to several hours, regardless of fatigue or mental factors, The administration of nitroglycerin does not relieve it.

2. Palpitation: Appears in 50% of patients, the cause is unknown. May be associated with arrhythmia such as frequent ventricular premature beats, paroxysmal supraventricular tachycardia or ventricular tachycardia, but dynamic electrocardiogram monitoring and atrioventricular beam electrogram examination found that some patients have no correlation with palpitations and arrhythmia high.

3. Difficulty breathing and fatigue: 40% of patients complain of shortness of breath, fatigue, often initial symptoms.

4. Others may have dizziness, fainting, vascular migraine, transient cerebral ischemia, and neuropsychiatric symptoms such as anxiety, nervousness, stress, fear and hyperventilation.

The patient's body shape is mostly weak, and can be accompanied by straight back, scoliosis or lordosis, funnel chest and so on.

Systolic reflux murmur. It is the noise generated by the blood flowing back from the high pressure heart chamber through the abnormal passage to the low pressure heart chamber, also known as reflow noise.

Differential diagnosis

Apical systolic murmur

Non-pathological apical systolic murmur rheumatic mitral valve, rheumatic mitral regurgitation, infective endocarditis rheumatic heart disease, systemic lupus erythematosus, scleroderma papillary dysfunction or lingual cord Fracture, (coronary heart disease, myocardial infarction) idiopathic ventral rupture, valve relaxation, mitral valve prolapse syndrome, Marfan syndrome, only obstructive cardiomyopathy, dilated cardiomyopathy, atrial septal defect, patent ductus arteriosus Endocardial pad defect, hyperthyroidism in pregnancy, anemia, ankylosing heart disease, heart disease, high altitude heart disease, third degree atrioventricular block cancer. Left, depleted aortic regurgitation, relative mitral regurgitation.

Aortic valve systolic murmur

Rheumatic aortic valve rheumatic aortic stenosis. Aortic atherosclerosis, hypertensive heart disease, aortic stenosis syndrome, congenital bicuspid aortic valve, aortic coarctation syphilitic aortitis, aortic aneurysm, Ebstein malformation, severe aortic regurgitation, Complete atrioventricular block. Hypertrophic heart disease, anorectal systolic murmur caused by other causes of anemia, carcinoid syndrome, and carotid murmur.

3rd and 4th intercostal systolic murmurs on the left sternal border

Ventricular septal defect in infants with non-pathologic systolic murmur, pulmonary stenosis or funnel stenosis, mitral regurgitation, aortic stenosis, aortic coarctation, atrial septal defect obstructive primary cardiomyopathy, tricuspid regurgitation Incomplete, patent ductus arteriosus, right ventricle, right atrium.

Pulmonary valve area systolic murmur

Non-pathological pulmonary systolic murmur rheumatic pulmonary valve disease, rheumatic pulmonary stenosis, infective endometritis, congenital pulmonary stenosis, pulmonary artery and branch stenosis Fallot tetralogy, Lutembacner syndrome, idiopathic pulmonary artery Dilated primary pulmonary hypertension, secondary pulmonary hypertension (Eisemmenger syndrome), rheumatic mitral stenosis chronic pulmonary heart disease, high altitude heart disease, atrial septal defect of straight back syndrome, arterial catheter Closed pulmonary venous malformation drainage, hyperthyroidism in pregnancy, anemia, ankylosing heart disease, carotid murmur.

Tricuspid systolic murmur

Rheumatic tricuspid valve rheumatic tricuspid regurgitation. Infective endocarditis, papillary muscle dysfunction valve relaxation. Electrical high radiation injury, Ebstein malformation pulmonary heart disease, rheumatic heart disease mitral valve disease and pulmonary hypertension caused by right ventricular enlargement, congenital heart disease, a large number of left-right shunt (atrial septal defect pulmonary vein malformation drainage), primary Pulmonary hypertension.

Continuous murmur at the bottom of the heart

Intravenous camping of the patent ductus arteriosus, the main pulmonary artery septal defect. Pulmonary arteriovenous and thin sinus aneurysms broke the right ventricle (atrial) congenital coronary arteriovenous thin, complete pulmonary venous malformation drainage tricuspid atresia, thoracic internal anastomosis after ventricular septal defect with aortic regurgitation, two The cusp regurgitation combined with aortic regurgitation, aortic regurgitation and stenosis.

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