Systolic heart murmur

The phenomenon of a systolic heart murmur may not be familiar to everyone. However, their presence is noteworthy, since they in most cases appear on the background of the development of serious diseases. It's kind of a signal to the body indicating that there were some problems with the heart.

What mean doctors are under the heart murmur

Using the term “noise”, in relation to the heart, cardiologists mean acoustic phenomenon associated with changes in blood flow in the blood vessels and the heart. Among the townsfolk is possible to meet opinion that the noise in the region of the heart is a problem specific to childhood. We have to admit - this view is close to the truth, because more than 90% of cases of detection of functional noise are recorded in adolescents and children. But the systolic murmur was diagnosed and young people aged from 20 to 28 years.

The opinions of many cardiologists regarding heart murmurs in adults converge: similar symptom points to a specific cardiac pathology, which in turn gives rise to full cardiac studies.

The Term "systolic" is most relevant to the noises that are heard between the second and first tones of the heart. The sound creates the bloodstream near the heart or its valves.

What kinds of noises it is possible to meet

In a clinical environment such a thing as a heart murmur, can be divided into several categories. It is a functional systolic murmur, the so-called innocent and organic, the presence of which indicates a particular pathology.

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Innocent murmurs have this name because they can be due to various diseases not related to heart. This means that they are not a symptom of a pathological condition of the heart. Tone this type of noise is soft, changeable, musical, short, have a quite weak intensity. Such noise weakens with decreasing physical activity and are not held outside of the heart. The nature of their change is not associated with the heart tones, but it depends on the position of the body.

As for the organic noises that arise due to the septal or valvular defects (mean defect of the interatrial or interventricular septum). The tone of these noises can be described as persistent, hard, rough. In intensity they are sharp and loud, with a significant duration. This type of noise is outside the heart in the axillary and interscapular region. After exercise organic noises are amplified and stored. They also, in contrast to the functional associated with the heart tones, and is equally clearly tapped at different position of the body.

Systolic murmur includes different types of acoustic phenomena in the heart:

early systolic murmur

- persistance (holosystolic);

- mid-to-late murmur;

- srednestatichesky noise.

Why is the heart there are various types of noise

If you pay attention to significant noise, which is perceived as a threat to health, it should be noted that they arise due to some key reasons.

Systolic heart murmur may be the consequence of aortic stenosis. Under this diagnosis, you need to understand congenital or acquired narrowing of the aorta orifice, through splicing of the valves the valve. This process makes difficult the normal flow of blood inside the heart.

Aortic stenosis can be attributed to one of the most common heart defects found in adults. In this disease often develop aortic insufficiency and mitral. Due to the fact that the aortic device has a tendency to calcification (when the stenosis progresses), the development of the disease increases.

In most cases, when severe fixed aortic stenosis, significantly overloaded left ventricle. At this time, the heart and brain begin to suffer from a lack of blood supply.

Aortic insufficiency can also be attributed to the reasons which develops systolic murmur. The essence of this disease is to ensure that the aortic valve cannot be completely closed. Myself aortic insufficiency often develops on the background of infectious endocarditis. To influence the development of this disease can rheumatic fever (more than half of cases), systemic lupus erythematosus, syphilis and atherosclerosis. The occurrence of this defect is extremely rare result of trauma or birth defects. Systolic murmur on the aorta may indicate the emergence of relative insufficiency of the aortic valve. This can lead to a sharp expansion of the fibrous ring of the valve and of the aorta.

Acute mitral regurgitation is another cause of systolic murmurs. In this case we are talking about the rapid movement of gases or liquids, which occurs in muscular hollow organs in the process of reduction. This movement has the opposite of the normal direction. Such a diagnosis in most cases is a consequence of disorders of the dividers.

Systolic murmur atthe pulmonary artery indicates the development in this area of the stenosis. With such a disease in the pulmonary valve, a narrowing of right ventricular outflow tract. This type of stenosis is approximately 8-12% of all congenital heart defects. This noise is always accompanied by systolic tremor. Especially pronounced irradiation of noise on the vessels of the neck.

To Mention is about the stenosis of the tricuspid valve. In this disease there is a narrowing of the tricuspid valve. Such changes most often are a result of rheumatic fever. The symptoms of this type of stenosis include cold skin, fatigue, discomfort in the upper right quadrant of the abdomen and neck.

Causes of systolic murmur in children

Factors that affect children's hearts, a lot, but most other are the following:

- atrial septal Defect. Under the defect implies the absence of tissue of the interatrial septum, leading to the discharge of the blood. The amount of reset depends on the compliance of the ventricles and size of the defect.

- the Anomalous venous return to the lungs. We are talking about the wrong formation of the pulmonary veins. More specifically, the pulmonary veins do not communicate with the right auricle, falling directly into the right atrium. It so happens that they fuse with the atrium through the veins of the great circle (right upper Vena cava, Vena azygos, the left brachiocephalic trunk, the coronary sinus and venous duct).

- coarctation of the aorta. Under this definition hides a congenital heart defect in which there is segmental narrowing of the aorta. In other words, segmental aortic lumen becomes smaller. This problem is treated through surgical intervention. If the diagnosis is not to take any action, the narrowing of the aorta of the child will increase as they Mature.

the ventricular septal Defect. This problem is also one of the reasons why recorded systolic heart murmur in a child. This defect is characterized by the fact that the defect develops between the two ventricles - left and right. This heart defect is often recorded in an isolated condition, although there are cases where such a defect is part of other heart defects.

- a Systolic heart murmur in a child causes can be associated with open arterial defect. It is a short vessel connecting the pulmonary artery and the descending aorta. The need for this physiological shunt is eliminated after the first breath of a baby, so within a few days it closes automatically. But if this is not happening (which, in fact, is the essence of the defect), the blood continues to shunt from the systemic circulation in small. If the ductus is small, it is, in principle, will not have a significantly negative impact on the health of the child. But when dealing with a large open arterial duct, there is a risk of serious overload of the heart. The symptoms of such a condition is frequent shortness of breath. If the duct is very large (9 mm or more), the newborn may be in critical condition. In this case, systolic murmur in children is not the only symptom - the heart is greatly increased in size. To neutralize this serious threat is used as an emergency.

We should also touch upon the category of newborns. The heart of the children after birth is bugged still in the hospital. This is done to exclude possible pathologies. But if there were recorded some noise, then do not make negative conclusions. The fact that, on average, every third child revealed certain noises. And not all of them are evidence of dangerous processes (do not have a negative impact on the development of the baby and not accompanied by blood circulation). It was during his (circulation) adjustment can generate functional murmur in a child who won't pose a threat to health. In this state, as x-rays and electrocardiogram will show normal development of the heart in infants.

As for the noise innate in infants, they are fixed for the first three months after birth. This diagnosis suggests that during the intrauterine formation of the heart the baby was not developed until the end and, as a consequence, has certain birth defects. If the degree of influence of heart failure on child development is too high, then maybe the doctors will decide about surgical intervention to eliminate the disease.

Features of the noise in the apex of the heart

This type of noise characteristics of the latter may vary depending on the cause and site of occurrence.

1. Acute mitral valve insufficiency. In this case, the noise can be described as short. He appears early (protoinstance). With the help of the Echo can be detected zones hypokinesia, the gap chords, signs of bacterial endocarditis, etc.

2. Chronic mitral valve insufficiency. Noises of this type occupy the period of ventricular contraction (holosystolic and persistance). There is a direct dependence of the valvedefect volume returning through a defect of the blood and the nature of the noise. Systolic murmur at the apex of the heart when these characteristics are best tapped in a horizontal position. If a defect will progress, there is a palpable vibration of the chest wall during systole.

3. Relative mitral insufficiency. If you spend a long examination (x-ray, Echocardiography), it is possible to identify the dilation of the left ventricle. Systolic murmur at the apex in this case can be maintained throughout the period of ventricular contraction, but it will be relatively quiet. If signs of stagnation in heart failure reduced, and is adequate therapy, the sonority of the noise will decrease.

4. Dysfunction of the papillary muscles. During the examination often reveals signs of myocardial infarction and (or) ischemia. This systolic murmur at the apex of the heart can be described as changeable. Moreover, it is characteristic appearance towards the end of systole or in its middle.

5. The mitral valve prolapse. Does not exclude the combination with a late systolic murmur. This type of listening is best in a vertical position. Similar noises depending on the condition of the patient can significantly vary. This systolic murmur at the apex is characterized by the manifestation in the middle of the systole (the so-called mesocestoides click).

Noise to the left of the sternum (the point Botkin)

The noise of this type for several reasons:

the ventricular septal Defect. Noticeable jitter of the thorax during systole, the left of the sternum. On the characteristics of the noise defect size has no effect. Heart hump detected in 100% of cases. Fixed rough systolic murmur, which occupies the entire systole, and is conducted in all departments. With the help of x-ray studies can reveal dilatation of the aortic arch and congestion of the lungs.

Congenital stenosis of the pulmonary artery. One of the main features is a symptom of feline murricane. When viewed noticeable heart hump (protrusion of the chest). The second tone above a pulmonary artery is weakened.

- Obstructive cardiomyopathy. Systolic murmur at the Botkin's point of this type is a medium and is able to change its intensity depending on the position of the body: if a person stands up, in a lying position - ceases.

- Tetard, Palau. These noises differ by the presence of the combination of the discharge of the blood from the left to the right chamber of the heart because of a defect in the septum between the ventricles and narrowing of the pulmonary artery. This noise is rough, with fixation of the systolic jitter. Noises are listened better at the bottom of the sternum. With ECG, you can fix the signs of hypertrophic changes of the right ventricle. But with the help of x-rays to detect pathology will not work. At any load manifests cyanosis.

Noise to the right of the sternum

At this point, (II intercostal space) aortic listened vices. The noise in this region indicate a narrowing or acquired with a congenital origin.

This systolic murmur has certain characteristics:

- the best place to detect is 4 and 5 intercostal spaces to the left of the sternum;

- persistancy, intense, tough and often a scraping noise;

- carried on the left side of the chest and reaches back;

in the sitting position the noise is amplified;

- x-ray examination detects the expansion of the aorta, calcification of its valve apparatus, and enlargement of the left ventricle;

the pulse has poor content and also rare.

The Progression blemish leads to the expansion of the left arterio-ventricular openings. In this situation there is a possibility listen to two different noises. If systolic murmur was triggered by congenital stenosis, will be present plus the tone of the exile, which is due to concomitant aortic regurgitate.

Heart murmur during pregnancy

During carrying a child may cause systolic murmurs. Most often they are functional in nature and due to the sudden increased load on the heart pregnant women. This condition is most typical in the third trimester. If the noise was fixed, then it is a signal to take the state of pregnancy (the kidneys, dosing loads, blood pressure) under close control.

If all these requirements are exactly met, then there is every chance that pregnancy, and childbirth, will be held positively, without negative consequences for the heart.

Diagnostics noise

First, how to begin the process of diagnosing heart disease is determination of the absence or presence of a heart murmur. The auscultation of the heart is held in a horizontal and in a vertical position, after physical exertion, on the left side, and at the height of inhalation and exhalation. Such measures are necessary in order for a systolic heart murmur, the cause of which can be completely different, been positively identified.

If we talk about mitral valve disease, then the best place to listen to the noise in this case is the tip of the heart. In the case of defects of the aortic valve should pay attention to the third intercostal space left of the sternum or the second on the right side. If you have to deal withvices of the tricuspid valve, then to listen systolic murmur is better in the lower edge of the body of the sternum.

On the topic of characteristics of noise, it is worth noting the fact that they may have a different power phase (systolic and diastolic), duration, variability and conductivity. One of the key tasks at this stage is the precise definition of one or more of the epicenters of noise. It is also important to consider the timbre of the noise, since this factor talks about the specific processes. If a light systolic murmur does not portend serious problems, rough, sawing, scraping indicates stenosis of the pulmonary aorta or the mouth of the aorta. In turn, the blowing noise is fixed with infective endocarditis and mitral insufficiency. Taken into account is the volume of the tones above the base and the apex of the heart.

It is Very important during diagnostic procedures initially to exclude extracardiac noise, that is, the source of which is outside of the heart. In most cases, these noises can be heard in pericarditis. But are determined by such acoustic phenomena only during systole. As an exception they can listen to during diastole.

To diagnose the condition of the heart uses a variety of technologies. Their use is necessary because the conclusions drawn on the basis of the obtained physical data need to be confirmed. To achieve this goal experts use FCG, ECG, x-rays of the heart in three dimensions, echocardiography, including transesophageal.

As an exception under strict indications use of invasive diagnostic techniques (sensing, contrast methods, etc.).

To measure the intensity of a heart murmur uses specific tests:

- physical activity (isometric, isotonic, and carpal dynamometry);

- breathing (increase in noise from the left and right parts of the heart on the exhale)

- fibrillation and premature beats of the Atria;

- positional changes (the rise of the legs in the standing position, change of body position of the patient and squats);

test Valsalva (recording of breathing when the mouth is closed and nose), etc.

Key findings

First of all, it is important to understand the relevance of modern diagnostics in the presence of a heart murmur. Its necessity is due to the fact that the systolic murmur may not portend significant problems for health, but at the same time can be a manifestation of serious disease.

Therefore, any noise that was discovered in the heart, must be explained by qualified physicians (you must correctly and accurately identify the cause). Is actually always a heart murmur have individual characteristics related to age periods. Any noise in the region of the heart deserves the attention of a doctor. The appearance of a heart murmur in a pregnant woman is sufficient reason to establish permanent control over its status.

Even in the absence of apparent heart problems or symptoms of any abnormalities, you need to pass the examination. It is often the identification of the systolic noise occurs randomly. Thus, the periodic diagnostics can detect disease at a stage when effective treatment possible.