Heart Murmur Sounds
This section describes several important attributes of heart murmur sounds.
Timing and Cadence
Our lessons often describe heart murmur timing within a cardiac cycle. Systolic murmurs occur between the first heart sound (S1) and the second heart sound (S2). Diastolic murmurs occur between S2 and S1. In addition, timing is used to describe when murmurs occur within systole or diastole. For example, early systolic, mid-systolic or late systolic.
See our courses on systolic and diastolic murmurs for more information including audio recordings, waveforms and animations:
Cardiac auscultation is performed systematically over five locations on the anterior chest wall. Use the stethoscope's diaphragm, switching to the bell to hear lower pitched sounds.
||Aortic Valve Area
||Second right intercostal space (ICS), right sternal border
||Pulmonic Valve Area
||Second left intercostal space (ICS), left sternal border
||Third left ICS, left sternal border
||Tricuspid Valve Area
||Fourth left ICS, left sternal border
||Mitral Valve Area
||Fifth ICS, left mid-clavicular line
Heart murmur duration refers to the portion of systole or diastole that the murmur occupies. Terms used include short and long. Murmurs lasting throughout systole are referred to as holosystolic or pansystolic.
Evaluation of the heart murmur's pitch should be made by classifying the pitch (frequency) as low, medium or high. The stethoscope's bell can be helpful with low pitched sounds while the diaphragm is used for medium or high pitched sounds.
A heart murmur can described by the sound's shape. Common classifications include crescendo (increasing intensity), decrescendo (decreasing intensity), crescendo-decrescendo (increasing then immediate decreasing intensity). Crescendo-decrescendo is also called diamond shaped. Rectangular, also termed plateau indicates a heart murmur of constant intensity.
Most of our lessons include a waveform with a moving cursor synchronized to the murmur audio. Many users find that the visual depiction of the murmur sounds is a useful educational tool.
Listen for additional aspects of the murmur's sounds. Heart murmurs may have qualities that can be noted as
musical, harsh, blowing, booming, sharp or dull.
Respiration and Patient Position
Respiration or patient position can influence murmur intensity as well as heart sound splitting. These factors will be described within the heart sound lessons. Generally speaking, murmurs increasing with expiration originate with left side (aortic or mitral) valves, while murmurs increasing in intensity with inspiration originate with tricuspid or pulmonary valves.
Within each lesson, the author provides an sketch of the patient's position during auscultation, such as supine, left lateral decubitus, squatting or sitting.
Heart Murmur Symptoms
Patients with an abnormal heart murmur may have symptoms or signs or symptoms of the underlying cause of the murmur:
- Chest pain
- Fainting or dizziness
- Bluish color on the fingertips, lips or skin
- Chronic coughing
- Sudden weight gain
- Enlarged neck blood vessels
- Shortness of breath
- Excessive sweating even with minimal or no exertion
- Enlarged liver
- Infants may eat poorly or have
- Infant failure to thrive
Heart Murmur Treatment
A heart murmur isn't a disease and does not require treatment. But some murmurs indicate an underlying condition. That condition may be treated by healthcare providers.