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BDX7 Combined Systolic, Diastolic and Continous Murmurs
Michael S. Feldman, MD, is Clinical Professor of Medicine at the University of Pennsylvania School of Medicine, and Chairman of the Graduate education Foundation. Bernard Segal, MD, is professor of medicine at Thomas Jefferson University Hospital, and director of the Jefferson Heart Institute. Here, they discuss combined systolic and diastolic and continuous murmurs. Auscultatory examples of the most common and significant murmurs are provided. The authors start out by discussing combined systolic and diastolic murmurs in atrial septic defect and ventricular septic defect. They describe the murmurs associated with patent ductus arteriosus and with pulmonary and mitral stenosis. They note that in both congenital and rheumatic heart disease a number of simultaneously occurring lesions produce a combination of systolic and diastolic "to and fro" murmurs. Focusing on continuous murmurs, the authors state that the most impressive of these is patent ductus arteriosus ... and they describe the continuous murmurs associated with aortopulmonary septal defect, coronary arterial fistula, and ruptured aneurysm of the sinus of Valsalva. Continuous murmurs may also be caused by Blalock or Potts surgical shunts to increase pulmonary blood flow in tetralogy of Fallot or tricuspid atresia. The lecture also covers continuous murmurs heard in pulmonary arteriovenous fistula and in cyanotic congenital heart disease and concludes with a discussion of such innocent continuous murmurs as venous hum and mammary soufflé. |
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