Ver el código de «Heart murmurs»

==Background==
[[File:Phonocardiograms from normal and abnormal heart sounds.svg|thumb|Phonocardiograms of common cardiac murmurs.]]
*Defined as a blowing, whooshing, or rasping sound heard during the cardiac cycle.
*Typically caused by turbulent blood flow.

==Clinical Features==
*Murmur on cardiac auscultation.

{| class="wikitable"
|+
!Region
!Location
!Heart Valve Association
|-
|Aortic
|2nd right intercostal space
|Aortic valve
|-
|Pulmonic
|2nd left intercostal spaces
|Pulmonic valve
|-
|Tricuspid
|4th left intercostal space
|Tricuspid valve
|-
|Mitral
|5th left mid-clavicular intercostal space
|Mitral valve
|}

==Differential Diagnosis==
{{Valvular emergencies DDX}}

==Evaluation==
===By Abnormal Lesion===
*[[Aortic Stenosis]] 
**Systolic murmur heard best in the aortic area; rarely at apex
**Crescendo-decrescendo, radiates to carotids
**A2 decreased
**Paradoxical splitting of S2; narrow pulse pressure
**Pulsus parvus et tardus
*[[Aortic Insufficiency]] 
**Diastolic blowing murmur heard at left sternal border in 3rd and 4th interspace
**Wide pulse pressure
**Quincke's sign (capillary pulsations at fingertips), DeMusset's sign (bobbing head), Muller's sign (pulsing uvula), and Corrigan's pulse (water hammer)
**Pistol shot sounds
*Pulmonic stenosis 
**Systolic murmur heard in pulmonic area, transmitted to back and neck
**A2 is decreased, P2 is delayed, and RVH with parasternal lift
*Pulmonic insufficiency
**High pitched diastolic murmur; heard in pulmonic area; decrescendo; RVH 
*[[Mitral Stenosis]] 
**Low rumbling diastolic murmur heard best at apex with bell
**Opening snap sometimes present worse with closer to S2
**Loud S1
**Associated with left atrial dilation
**Can hear presystolic sound confused with systolic murmur
*[[Mitral Insufficiency]] 
**Loud, holosystolic, high-pitched, heard best at apex and transmitted to axilla
**Soft S1
**Severity gauged by s3, rumble. 
**Paradoxical splitting

===Specific Sounds===
*Gallavardin Effect 
**AS sounds like MR - high frequency vibrations to the apex through a calcific AV 
*Austin-Flint 
**MS sounds like AR - Soft, rumbling murmur, likely due to functional mitral valve stenosis as the backflow of blood from the aorta presses on anterior leaflet of MV
*Parodoxical S2 
**Splittin during expiration and goes away during inspiration
**Secondary to inc left sided volume; AS, HOCM 
*Wide S2 
**secondary to Inc right sided volume; PE, ASD, [[VSD]], Pulmonic stenosis 
*S3 
**AKA ventricular gallop produced during passive LV filling when blood strikes a compliant LV; CHF, Inc Vol, CAD, benign in youth, train athletes 
*S4 
**AKA atrial gallop produced when blood is forced into a stiff/hypertrophic ventricle&nbsp;;MI, hypertension, restrictive cardiomyopathy

===Diagnostic Maneuvers===
*Valsalva 
**Increases thoracic pressure and lowers preload; then then decreased CO and afterload 
**Increases murmur in MP &amp; HOCM 
**With release: right heart murmurs return first 
*Hand grip 
**Increases HR + CO 
**Increases murmur in MR, MS, AR 
**Decreases murmur in AS and [[HOCM]] 
*Squatting 
**Increased venous return 
**Delays MP click 
*Standing 
**Dec in both right &amp; left venous return &amp; SV 
**Decreases murmur of PS, AS, AR, TR, [[VSD]] 
**Increases murmur of HOCM 
*Inspiration 
**Increases right sided venous return while decreasing left sided return 
**Increases S2 splitting with P2 further from A2 
**Increases in right sided S3 &amp; S4 
**Increases TS opening snap &amp; murmur, PR, TR 
**Decreases MS opening snap, MVP murmur

==Management==

==Disposition==

==See Also==
*[[Valvular emergencies]] 
*[[Innocent Murmurs (Peds)]]

==External Links==

==References==
<references/>
[[Category:Cardiology]]