<< Back |
||||||||||||
BDX5 Holosystolic, Early and Late Systolic 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. In this fifth of a seven-part series, they explain the causes and varying sounds of pansystolic, early and late systolic murmurs. Auscultatory examples of the most common and significant murmurs are provided. The major causes of pansystolic murmurs are mitral or tricuspid regurgitation and ventricular septal defect. The authors describe how the pansystolic murmur in mitral regurgitation is best heard, and list some of the descriptive terms used to qualify it … such as rough, harsh, or musical. The pansystolic murmur in tricuspid regurgitation, they point out, may resemble that of mitral regurgitation but is distinguished by the effect of inspiration on its intensity and by its transmission. A pansystolic murmur in ventricular septal defect may also be very similar to those heard in mitral and tricuspid regurgitation but subtle differences in location, transmission, intensity, and quality help in differentiation. Intracardiac phonocardiography will support the accuracy of stethoscopic findings. Early systolic murmurs begin with the first heart sound and end in mid systole, while late systolic murmurs begin after mid-systole and end with the aortic component of the second heart sound. They are generally associated with mitral and tricuspid valve prolapse, and may occasionally be heard with coarctation of the aorta, or in patients with moderate mitral regurgitation. The lecture concludes with a discussion of coronary artery disease and its frequent association with systolic murmurs. The lecture provides both graphic and audio accompaniment. |
||||||||||||
