Heart Murmurs, a brief tutorial with audio files

[Kademad]

Hi guys, how is it going?
I know that all of you are freaked out in regard to Heart Murmurs(although u shouldn't), and I'm sure that many of you didn't have the chance to listen to real murmurs, so I thought I could help by finding some audio files and putting them here along with some brief explanation & some notes; wishing that it can make things easier for you.

here we go....

first let's start by listening to Normal Heart Sound (in .rm and requires Real Player)

then...
Aortic Regurgitation Murmur


A diastolic murmur heard best at the Pulmonic area, accentuated by expiration and sitting up, leaning forward.

Expiration is associated with decreased negative intrathoracic pressure and reduced venous return to the heart. Right-sided flow is decreased, and splitting of S2 diminishes or disappears. However, murmurs and sounds originating on the left side of the heart (such as the left-sided S3 and S4, the mitral opening snap, and the murmurs of aortic stenosis and aortic regurgitation) are accentuated during expiration. In addition, the right sided pulmonary ejection click may be appreciated best in expiration.
Sitting Up, Leaning Forward tends to bring out the murmurs of aortic and pulmonic regurgitation, in addition to the murmur of aortic stenosis.

(right click -> save target as)
Aortic Regurgitation (download & listen)
or in .rm format (requires Real Player)
Aortic Regurgitation



Aortic Stenosis Murmur


A systolic murmur heard best at the Aortic area, accentuated by expiration and sitting up, leaning forward.

Expiration is associated with decreased negative intrathoracic pressure and reduced venous return to the heart. Right-sided flow is decreased, and splitting of S2 diminishes or disappears. However, murmurs and sounds originating on the left side of the heart (such as the left-sided S3 and S4, the mitral opening snap, and the murmurs of aortic stenosis and aortic regurgitation) are accentuated during expiration. In addition, the right sided pulmonary ejection click may be appreciated best in expiration.
Sitting Up, Leaning Forward tends to bring out the murmurs of aortic and pulmonic regurgitation, in addition to the murmur of aortic stenosis.

(right click -> save target as)
Aortic Stenosis (download & listen)
or in .rm format (requires Real Player)
Aortic Stenosis


Mitral Regurgitation Murmur


A mitral regurgitation murmur is a systolic murmur heard best at the Mitral area, accentuated by exercise and heard best in the left semilateral position.

Exercise is associated with an increased heart rate, shorter diastole, elevated left atrial pressure, more abrupt closure of the heart valves, and increased blood velocity. These changes help account for the increased intensity of S1, S2, the mitral opening snap, the left-sided S3 and S4, the right-sided S4, and the murmurs of mitral regurgitation, mitral stenosis, and patent ductus arteriosus, noted in normal patients immediately following exercise.
The Left Semilateral Position can be used to accentuate the mitral opening snap and mitral regurgitation murmurs, in addition to the left-sided S3 and S4.

(right click -> save target as)
Mitral Regurgitation (download & listen)
or in .rm format (requires Real Player)
Mitral Regurgitation




Mitral Stenosis Murmur


A mitral stenosis murmur is heard best in the mitral area, accentuated by exercise and having the patient assume a recumbent position.

The Recumbent Position often accentuates the murmurs of mitral and tricuspid stenosis.
Exercise is associated with an increased heart rate, shorter diastole, elevated left atrial pressure, more abrupt closure of the heart valves, and increased blood velocity. These changes help account for the increased intensity of S1, S2, the mitral opening snap, the left-sided S3 and S4, the right-sided S4, and the murmurs of mitral regurgitation, mitral stenosis, and patent ductus arteriosus, noted in normal patients immediately following exercise.

(right click -> save target as)
Mitral Stenosis (download & listen)
or in .rm format (requires Real Player)
Mitral Stenosis



Tricuspid Regurgitation Murmur


A tricuspid regurgitation murmur is a systolic murmur heard best at the Tricuspid area, accentuated by inspiration.

Inspiration is associated with increased negative intrathoracic pressure, increased venous return to the heart, increased right ventricle stroke volume, and decreased pulmonary vascular resistance. These changes tend to increase the intensity of right-sided S3 and S4 gallops, mitral and tricuspid clicks, tricuspid and pulmonic stenosis, and tricuspid and pulmonic regurgitation murmurs. Splitting of S2 is also more apparent during inspiration when bloodflow into the right side of the heart is increased and right ventricular ejection is prolonged.

sorry, no exact audio file, but I think it's similar to that of Mitral Regurgitation.




Tricuspid Stenosis Murmur


A diastolic murmur heard best at the Tricuspid area, accentuated by inpiration and having the patient assume a recumbent position.

Inspiration is associated with increased negative intrathoracic pressure, increased venous return to the heart, increased right ventricle stroke volume, and decreased pulmonary vascular resistance. These changes tend to increase the intensity of right-sided S3 and S4 gallops, mitral and tricuspid clicks, tricuspid and pulmonic stenosis, and tricuspid and pulmonic regurgitation murmurs. Splitting of S2 is also more apparent during inspiration when bloodflow into the right side of the heart is increased and right ventricular ejection is prolonged.
The Recumbent Position often accentuates the murmurs of mitral and tricuspid stenosis.

sorry, no exact audio file, but I think it's similar to that of Mitral Stenosis.




Mitral Valve Opening Snap


The Opening Snap of the Mitral Valve is heard best midway between the pulmonic and mitral areas. The MVOS has a quality similar to the normal heart sounds and is often confused with a splitting S2. The brief, sharp, rather snapping sound is heard shortly after the A2 component of S2. When loud, it is widely transmitted over the entire precordium. Optimum audibility is often achieved by turning the patient to the left lateral position. Standing tends to lower the left atrial pressure and thus increase the A2-OS interval. A soft OS may be intensified after exercise that increases atrial pressure. The A2-OS interval is not altered during different phases of respiration; however, the MVOS is usually loudest on expiration.

(right click -> save target as)
Opening Snap (download & listen)



Other Audio Files:
Pansystolic Murmur
Early Systolic Murmur
Late Systolic Murmur
Ejection Click



Finally I want to say that Macleod's has some great illustrations that will help you understand what you're listening to.

wish you all the best

[lavie]

very nice and interstening,thanks for ur efforts in helping us






FM

[Kademad]

u're most welcome

[muhanned]

nice ..tnx alot.

[Mehmet_Nabeel]

Thank you ya a7la administrator

[doctnader]

شكرا يا كاظم الورد

[riyadh saad]

all i can see 2 u thx alot ya warda

[Dr.Leo1984]

[SIZE=7] shno enta