II. Causes: Mid-Systolic Murmurs
- Innocent Murmur
- Physiologic Murmur
- Pathologic
- Hypertrophic Cardiomyopathy (20 per 10,000 births)
- Murmur 2-4/6 at left lower sternal border and apex, increased with Valsalva Maneuver
- Atrial Septal Defect (5.4 per 10,000 births)
- Murmur 1-3/6 at left upper sternal border, radiating to back, with fixed split S2 Heart Sound
- Aortic Coarctation (4 per 10,000 births)
- Murmur 1-3/6 at left Scapular region
- Aortic Stenosis (3.8 per 10,000 births)
- Murmur 2-3/6 at right upper sternal border, radiating to carotid arteries
- Pulmonic Stenosis (<1 per 10,000 births)
- Murmur 1-3/6 at left upper sternal border, radiating to back and lung fields
- Hypertrophic Cardiomyopathy (20 per 10,000 births)
III. Causes: Holosystolic Murmur (Pansystolic Murmur, or early murmur)
-
Ventricular Septal Defect (30 per 10,000 births)
- Murmur 3-4/6 (less in larger VSD) harsh, at lower left sternal border, increased with hand grip
-
Mitral Regurgitation (5 per 10,000 births)
- Murmur 2-3/6 at apex radiating to axilla, with possible S3 Heart Sound (pansystolic or early blowing murmur)
-
Patent Ductus Arteriosus (newborns, 5 per 10,000 births)
- Murmur 2-4/6 at left upper sternal border, machinery sound (to and fro), also heard as Diastolic Murmur
- Tricuspid Regurgitation (<1 per 10,000 births)
- Murmur 2-3/6 at lower left sternal border
IV. Exam
- See Heart Murmur
- Dynamic Maneuvers: Affecting Left Ventricular Preload (most useful single set of dynamic tests)
- Decreased Left Ventricular Preload (e.g. Valsalva, stand from squat, forced heavy expiration)
- Increases Hypertrophic Cardiomyopathy and Mitral Valve Prolapse Systolic Murmurs
- Decreases Aortic Stenosis, Mitral Regurgitation and innocent Systolic Murmurs
- Increased left Ventricular Preload (e.g. Squat, passive leg raise)
- Increases innocent Systolic Murmurs as well as Mitral Regurgitation and Aortic Stenosis
- Decreases Hypertrophic Cardiomyopathy and Mitral Valve Prolapse Systolic Murmurs
- Decreased Left Ventricular Preload (e.g. Valsalva, stand from squat, forced heavy expiration)
- Dynamic Maneuvers: Other
- Increased Afterload (e.g. hand grip, transient arterial Occlusion with Blood Pressure cuff)
- Increases Mitral Regurgitation, pulmonic stenosis and Ventricular Septal Defect Systolic Murmurs
- Decreases Hypertrophic Cardiomyopathy, Aortic Stenosis and Mitral Valve Prolapse Systolic Murmurs
- Increased venous return and increased left Ventricular Afterload (e.g. deep or exaggerated inspiration)
- Increases tricuspid regurgitation, pulmonic stenosis Systolic Murmurs
- Decreased jugular venous return (Jugular Vein compression, or transition supine from sitting)
- Decreases Venous Hum continuous murmur
- Increased Afterload (e.g. hand grip, transient arterial Occlusion with Blood Pressure cuff)
V. References
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Heart murmurs which are systolic in timing. They occur between the first and the second HEART SOUNDS, between the closure of MITRAL VALVE and TRICUSPID VALVE and the closure of semilunar aortic and pulmonary valves. Systolic murmurs include ejection murmurs and regurgitant murmurs. |
| Concepts | Finding (T033) |
| MSH | D054160 |
| SnomedCT | 31574009 |
| LNC | LA17241-3 |
| Dutch | systolisch geluid, systolisch geruis |
| German | systolischer Bruit, systolisches Geraeusch, Systolische Herzgeräusche |
| Italian | Soffio sistolico, Soffi sistolici |
| Portuguese | Sopro sistólico, Sopros Sistólicos |
| Spanish | Arrastre sistólico, Soplo sistólico, Soplos Sistólicos, Soplo Sistólico, soplo sistólico (hallazgo), soplo sistólico |
| Japanese | 収縮期性心雑音, ｼｭｳｼｭｸｷｾｲｼﾝｻﾞﾂｵﾝ, ｼｭｳｼｭｸｷｻﾞﾂｵﾝ, 心雑音-収縮期, 収縮期雑音 |
| English | Murmurs, Systolic, Systolic Murmur, Systolic Murmurs, Murmur, Systolic, Systolic bruit, Systolic Murmurs [Disease/Finding], systolic murmur, murmur systolic, systolic heart murmur, systolic murmurs, heart murmurs systolic, Systolic murmur (diagnosis), functional murmur systolic, Murmur-systolic, Systolic murmur, SM - Systolic murmur, Systolic murmur (finding), Systolic murmur, NOS |
| Finnish | Systoliset sivuäänet |
| French | Souffle systolique, Murmure systolique, Souffles systoliques, Murmures systoliques, Clic systolique |
| Russian | СИСТОЛИЧЕСКИЕ ШУМЫ, SISTOLICHESKIE SHUMY |
| Swedish | Systoliska blåsljud |
| Czech | Systolický šelest, systolické šelesty |
| Polish | Szmery wyrzutowe, Szmery skurczowe |
| Hungarian | Szisztolés zörej |
| Norwegian | Systolisk bilyd |
