Wednesday, 23 July 2014


Important Murmurs
Austin Flint murmur : Austin Flint murmur is
a mid-diastolic rumbling audible in subjects
with severe aortic regurgitation that is best
heard at the apex with little radiation.
Several theories have been suggested for the
origin of the murmur: (1) vibration of the
anterior mitral valve leaflet due to the
regurgitant jet, (2) collision of the jet with
mitral inflow, (3) increased mitral inflow
velocity due to narrowing of the valve orifice
by the jet, and (4) vibration from the jet
impinging on the myocardial wall. It differs
from mitral stenosis murmur in that ,it
occurs in the presence of a murmur of aortic
valve insufficiency and in the absence of the
rheumatic, mitral opening snap.
Carey Coombs murmur : Mitral valvulitis
associated with acute rheumatic fever may
cause a low-pitched mid-diastolic rumble. It
can be differentiated from the diastolic
murmur of Mitral stenosis by the absence of
(1)an opening snap, (2)presystolic
accentuation & (3)loud first heart sound.
Cruveilhier-Baumgarten murmur : Venous
hum heard in epigastric region (on
examination by stethoscope) due to collateral
connections between portal system and the
remnant of the umbilical vein in portal
Duroziez's murmur : Its a to & fro murmur
heard over the femoral artery during both
systole& diastole. It is elicited by applying
gradual arterial compression with the
diaphragm of the steth. This compression
not only produces systolic murmur(which is
the normal result of arterial compression) but
also a diastolic murmur(which is pathologic
& suggestive of aortic
regurgitation).Sensitivity of 58-100%.False
positives occur in high output states. In high
output states the double murmur is due to
forward flow. In Ar one murmur is due to
forward flow& the other due to reverse
flow.The two can be differnetiated by
applying pressure first on the more cephalad
edge of the diaphragm & then on its more
caudal edge. The murmur of forward flow is
enhanced by compressing the cephalad edge.
Conversely the reverese flow murmur is
enhanced by compressing the caudad edge.
Gibson murmur :The typical continuous
"machinery-like" murmur of patent ductus
arteriosus.train in tunnel murmur
Graham Steell's murmur : Due to pulmonary
regurgitation in patients with pulmonary
hypertension and mitral stenosis. It is a high
pitched early diastolic murmur heard best at
the left sternal edge in the second intercostal
space with the patient in full inspiration.
The murmur is heard due to a high velocity
regurgitant flow across the pulmonary valve;
this is usually a consequence of pulmonary
hypertension. The Graham Steell murmur is
often heard in patients with chronic cor
pulmonale as a result of chronic obstructive
pulmonary disease.
Means-Lerman "scratch" murmur: Increased
flow across the pulmonary valve in
Thyrotoxicosis may be associated with
ejection systolic murmur.The ejection systolic
murmur owing to hyperthyroidism may have
a scratchy quality (Means-Lerman scratch ),
and, frequently, the intensity of P2 is
increased because of mild to moderate
pulmonary hypertension.
Roger's Murmur:A loud pansystolic murmur
caused by interventricular septal defect of the
heart; maximal at the left sternal border.
Seagull murmur a raucous murmur with
musical qualities, such as that heard
occasionally in aortic insufficiency.A
"seagull’s cry murmur" is defined as a
murmur imitating the cooing sound of a
seagull. This type of murmur is typically
characterized by a musical timbre and a high
frequency, and may occur as a result of
various valve diseases. It is usually described
as a sign of tight calcific aortic stenosis,
when the murmur’s high frequency
components are transmitted to the lower left
sternal border and the cardiac apex during
most of systole (Gallavardin’s phenomenon).
In this condition, the typical harsh timbre of
the ejective murmur tends to assume a
musical high pitched quality, resembling that
of mitral regurgitation, which may be
reminiscent of the cry of a seagull. A
protodiastolic murmur with similar
characteristics, typically in decrescendo, may
occur in severe aortic valve regurgitation,
particularly when the regurgitant flow
presents high velocities. However, a seagull’s
cry murmur may also be the sign of mitral
regurgitation or prolapse. Similarly, the
musical and holosystolic sound reflects the
presence of high frequency components due
to high velocities of reflow.
Still's murmur An innocent musical murmur
resembling the noise produced by a twanging
string; almost exclusively in young children,
of uncertain origin and ultimately
disappearing.{There are five innocent
murmurs of infancy and childhood: (i)
pulmonary flow murmur, (ii) Still's murmur,
(iii) venous hum, (iv) carotid bruit, (v)
physiologic pulmonary branch stenosis
murmur of neonate}

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