What Is an Innocent Heart Murmur?

Heart murmur (cardiac murmur) refers to the abnormal sounds produced by the vibration of the walls, valves, or blood vessels caused by turbulence in the heart or blood vessels when the heart contracts or relaxes, in addition to heart sounds and extra heart sounds. Noise with different intensity and longer duration. Heart murmurs can be seen in healthy people and more often in patients with cardiovascular disease. Some murmurs are the main basis for diagnosing heart disease. For example, mitral stenosis can be diagnosed if there is a progressive rumbling murmur in the middle apex with pre-systolic systole.

Basic Information

Visiting department

Cardiology

Common locations

heart

Common causes

Rheumatic mitral valve inflammation, rheumatic mitral regurgitation, infective endocarditis, rheumatoid heart disease, systemic lupus erythematosus, etc.

Common symptoms

Noises with different frequencies, different intensities, and longer duration than heart sounds and extra heart sounds

Causes of cardiac murmur and common diseases

Apical systolic murmur

Rheumatic mitral valve inflammation, rheumatic mitral valve insufficiency, infective endocarditis, rheumatic heart disease, systemic lupus erythematosus, scleroderma papillary muscle insufficiency or broken cord, (coronary heart disease, myocardial infarction ) Idiopathic tendon rupture, valve relaxation, mitral valve prolapse syndrome, hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, atrial septal defect, arterial duct occlusion, hyperthyroidism heart disease during pregnancy, anemia Heart disease, beriberi heart disease, third degree atrioventricular block carcinoid syndrome. Left heart failure aortic valve insufficiency, relative mitral valve insufficiency, etc.

2. Diastolic murmur in the apical region

Rheumatic mitral valve inflammation, rheumatic mitral stenosis, infective endocarditis, rheumatoid heart disease, systemic lupus erythematosus, larger mitral valve vegetation or thrombus, constrictive pericarditis, Hurler Syndrome, arterial duct closure, severe mitral regurgitation, severe aortic regurgitation, ventricular septal defect with high bifurcation, hypertensive heart disease, aortic constriction, dilated cardiomyopathy, hyperthyroidism Diastolic murmur in the apical region due to heart disease, third-degree atrioventricular block, and other causes.

3. Aortic valve systolic murmur

Rheumatic aortic valve inflammation, rheumatic aortic stenosis, aortic atherosclerosis, hypertension aortic stenosis syndrome, congenital two-leaf aortic valve, aortic constriction, syphilitic aorta Inflammation, aortic aneurysm, Ebstein deformity, complete atrioventricular block. Aortic valve systolic murmur due to hyperthyroid heart disease, anemia heart disease, and other reasons.

4. Diastolic murmur in the aortic valve area

Rheumatic aortic valve inflammation, rheumatic aortic valve insufficiency, syphilitic aortic valve insufficiency, infective endarteritis, rheumatoid heart disease, Marfan syndrome, aortic atherosclerosis, hypertension Aortic valve dilatation and other causes of aortic valve insufficiency.

5. The third and fourth intercostal systolic murmurs on the left margin of the sternum

Ventricular septal defect, non-pathological systolic murmur in infants, pulmonary valve stenosis or funnel stenosis, mitral valve insufficiency, aortic valve stenosis, aortic constriction, atrial septal defect obstructive primary cardiomyopathy, tricuspid Insufficient valve closure.

6. Pulmonary valve systolic murmur

Non-pathological pulmonary systolic murmur, rheumatic pulmonary valvulitis, rheumatic pulmonary valve stenosis, infective endometritis, congenital pulmonary artery stenosis, pulmonary artery and branch stenosis, Fallot tetralogy, idiopathic pulmonary vasodilation , Primary pulmonary hypertension, secondary pulmonary hypertension (Eisemmenger syndrome), rheumatic mitral stenosis, chronic pulmonary heart disease, high altitude heart disease, straight back syndrome atrial septal defect, arterial duct failure Closed, anemia heart disease, etc.

7. Diastolic murmur in pulmonary valve area

Rheumatic pulmonary arteritis, rheumatic pulmonary insufficiency, infective endocarditis, relative pulmonary insufficiency due to pulmonary stenosis, Granam-stell murmur caused by primary pulmonary hypertension, rheumatic mitral stenosis, Congenital heart disease, left to right shunt), congenital pulmonary aneurysm, anemia heart disease, hyperthyroidism heart disease, etc.

8. Tricuspid systolic murmur

Rheumatic tricuspid valve inflammation, rheumatic tricuspid valve insufficiency. Infective endocarditis, papillary muscle insufficiency, valve relaxation. Ebstein malformation, pulmonary heart disease, rheumatic heart disease, mitral valve disease, and pulmonary hypertension leading to a significant enlargement of the right ventricle, a large number of left-right shunts of congenital heart disease (atrial septal defect pulmonary vein malformation drainage), and primary pulmonary hypertension .

9. Diastolic murmur in tricuspid valve area

Rheumatic tricuspiditis, rheumatic tricuspid stenosis, endarteritis, congenital mitral stenosis, right atrial myxoma, mitral stenosis caused by right ventricular enlargement, tricuspid regurgitation, massive reflux, atrial There are a large number of left and right shunts, anemia heart disease, hyperthyroid heart disease, and carcinoid syndrome.

10.Continuous murmur at the bottom of the heart

Vein yingying, arterial duct open, main pulmonary artery septal defect. Pulmonary arteriovenous aneurysm, aortic sinus aneurysm breaking into the right ventricle (atrial), congenital coronary arteriovenous aneurysm, complete pulmonary vein malformation drainage tricuspid valve atresia, ventricular septal defect with aortic valve insufficiency after intrathoracic anastomosis , Mitral valve insufficiency with aortic valve insufficiency, Aortic valve insufficiency with stenosis.

Cardiac murmur

General inspection

If you have cyanosis, clubbing fingers (toes), or asthma, consider congenital cardiovascular malformations. The left margin of the sternum is mainly found in congenital heart disease or chronic rheumatic heart valve disease, and can also be caused by a large amount of pericardial exudate during childhood. There is a bulge or systolic impulse at or near the second intercostal space of the right margin of the sternum, which is mostly a sign of aortic arch aneurysm. Emphysema, pericardial effusion or left pleural effusion, pneumothorax signs can often mask or weaken the original heart murmur.

2. Heart auscultation

The patient should take a sitting or supine position, and if necessary, can ask the patient to change position. For example, the mitral valve murmur is often heard clearly in the left lying position; the murmur of aortic valve insufficiency is more clear in the sitting or standing position. During auscultation, you should also pay attention to the time of the murmur in the cardiac cycle (systole or diastole), the loudest part, the pitch level, the loudness, the sound quality (air blow, rumbling, machine sound, music sound), whether conduction, conduction Direction, exercise, breathing, body position, etc. to determine its clinical significance.

3. Other

If necessary, a chest radiograph, electrocardiogram, and echocardiography are performed to make a precise assessment of the condition.

Differential diagnosis of cardiac murmur

Pericardial fricative

The pericardial friction sound is high-pitched, similar to the sound produced by leather friction, and is often louder in the 3 to 4 intercostal space on the left edge of the sternum. It can occur during systole, diastole or second phase, and is communicative, which can cover heart sounds. Generally in the seated position, with the upper body leaning forward slightly (easy to hear when holding your breath, the sound is enhanced when the stethoscope chest piece is pressurized. When the friction sound is bright and rough, it is similar to the systolic murmur, but it has a short duration, only a few hours to a few days This is different from murmurs. The pericardial friction sounds auscultate like pleural friction sounds, but the pleural friction sounds disappear when you stop breathing, while the pericardial friction sounds still appear with the heart beat.

2. Cardiopulmonary murmur

When the heart beats, it is caused by squeezing the lungs near the heart to cause air movement in the lungs, which mostly occurs during systole. The murmur is limited to the middle phase of contraction, with a high pitch, and is easy to hear on the right apex and along the left edge of the heart. Clearer when inhaling. Can suddenly disappear. Seen when the pleura and mediastinum are widely adhered, also seen in normal people.

3. Peripheral vascular noise

When the artery is locally dilated (such as an aneurysm) or narrowed (such as atherosclerosis, constrictive arteritis tip), it is not necessary to pressurize at the lesion site, which is equivalent to the systole of the heart to hear murmur. Arteriovenous fistula can hear continuous murmur, aortic valve insufficiency, with a stethoscope chest piece gently press the brachial artery or femoral artery and other aorta, you can smell two murmurs, called Dirozier's double murmur. Aortic stenosis systolic heart murmur can be heard along the bloodstream and heard at the right subclavian or carotid artery. Continuous murmurs can also be heard at the varicose veins.

4. Pleural fricative

Pleuritis, incomplete inflammatory adhesions of the pleura, pleural tumor nodules, when the pleura is highly dry (such as cholera), the pleura becomes dry, and the two layers rub against each other and emit a dry, intermittent sound during breathing. At the end of exhalation, it is clearest at the beginning of inhalation. Hold your breath and stop it. Breathe deeply and pressurize with the chest piece of the stethoscope to strengthen it. When the pleural friction sounds occur near the heart, each heartbeat will cause friction sounds--pleural pericardial friction sounds .

Cardiac murmur treatment principles

1. If there is a noise in the heart, you should go to the hospital regularly to check the nature of the noise. If it's physiological, don't worry about it.

2. If the murmur is suspected to be pathological, it is necessary to determine whether there is an organic heart disease and timely treatment for the cause.

3. Anyone with pathological murmur caused by congenital heart disease or rheumatic heart disease should limit physical activity to prevent heart failure and severe arrhythmia. Doctors need to be checked to determine whether there are indications for surgical repair or valve replacement .

4. It is suggested that patients with congenital heart disease, rheumatic heart disease or mitral valve prolapse should be given antibacterial drugs prophylactically before tooth extraction.