Transient apical systolic murmur

Introduction "Transient" means that a clinical symptom or sign appears once or several times in a short period of time, often with obvious incentives, such as eating a certain food, taking a certain drug, receiving some kind of clinical treatment or other After the factors that cause the effects, the symptoms or signs will quickly disappear as the cause is removed. Systolic murmur is one of the most common clinical murmurs that can be functional or organic. Functionality is more common in heart murmurs.

Cause

The cause of transient apical systolic murmur:

May have unstable angina. Physical examination to prevent unstable angina: Physical examination is usually not helpful in affirming or excluding angina. Abnormal pulsation in the anterior region and short-term diastolic tone often suggest left ventricular dysfunction. During or after ischemia, there may also be manifestations of acute papillary muscle dysfunction, such as transient apical systolic murmurs, clicks, and so on.

an examination

Related inspection

Chest MRI chest B-ultrasound

Examination and diagnosis of transient apical systolic murmur:

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

1. Chest pain: incidence rate 60% ~ 70% in the anterior region, can be dull pain or knife pain, usually mild, duration of minutes to hours, regardless of fatigue or mental factors, including Nitroglycerin does not relieve it.

2. palpitations: in 50% of patients, the cause is unknown, may be related to arrhythmia such as frequent ventricular premature beats, paroxysmal supraventricular tachycardia or ventricular tachycardia, but dynamic electrocardiogram monitoring and atrioventricular bundle Electrogram examination found that some patients had a low correlation between palpitations and arrhythmia.

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

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

Differential diagnosis

Transient apical systolic murmur confusing symptoms

Clinical features of diastolic murmurs often associated with diastolic murmurs are:

1, apical part: 1 organic: mainly seen in rheumatic valvular disease mitral stenosis auscultation is characterized by diastolic middle and late rumbling-like murmur, increasing type, low pitch, confined to the apex, the left lateral position is clearer Often accompanied by diastolic tremor and first heart sound hyperthyroidism or open flap sound. 2 relativity: seen in the relative mitral stenosis caused by aortic regurgitation, which is due to the reflux of blood to increase the left ventricular blood volume and diastolic pressure, the anterior mitral lobes are pushed higher The location shows a relative stenosis of the mitral valve, so a diastolic rumbling murmur can be heard at the apex of the heart, called Austin Flint murmur. The auscultation features soft, descending, diastolic, early and middle rumbling, without tremor The diastolic sigh-like murmur of the first heart sound can be sighed or opened, and the diastolic sigh-like murmur of the aortic regurgitation can be distinguished according to the above identification point and the organic mitral stenosis.

2, aortic valve area: mainly seen in rheumatic valvular disease aortic valve regurgitation and other organic valvular disease, auscultation is characterized by early diastolic, showing a decreasing type, sigh-like murmur, in the third intercostal space on the left sternal border ( The second auscultation area of the aortic valve is most obvious. The seat and the end of the breath can be heard more clearly. The noise is transmitted along the left edge of the sternum and reaches the apex.

3, pulmonary valve area: organic lesions are rare, mostly due to pulmonary artery expansion caused by relative closure of the pulmonary valve, resulting in diastolic murmur, known as Graham Steel murmur, common in mitral stenosis, pulmonary heart disease, atrial septum Defect, primary pulmonary hypertension, etc. The auscultation features a descending type, a sigh-like or sigh-like diastolic murmur, which is most clearly seen in the second intercostal space on the left sternal border. It is transmitted to the third intercostal space, and is enhanced when lying down or inhaling, such as with right ventricular enlargement and heart cis. The clock is turned, and the noise can sometimes be transmitted to the apex.

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