Cardiovascular Diseases / / May 12, 2016
Alternative names: systolic heart murmur (noise, listens during ventricular contraction between the first and second heart tones);diastolic heart murmur (heart sounds are heard in the range from II to I heart sound, ie during the period of ventricular diastole)
Heart murmurs - blowing, whistling or squeaky sound could be heard when listening to the heartbeat.Sounds are usually created by blood flow through the heart valves or near.
heart consists of four chambers: two upper chambers (atria) and two lower chambers (ventricles).The heart has valves that close when his every stroke, causing bleeding in only one direction.Valves are arranged between the chambers.
When listening to a stethoscope a healthy heart usually hear sounds that can be described as «Lub, dup, Lub, dup».The combination of «Lub» sounds characterizes the noise generated by the closing of the atrioventricular valves at the beginning of ventricular systole, which is called the first heart tone.The combination of «dup» sounds char
The simplest explanation of heart tones is as follows: leaf valves "collapse", and there is a vibration or shaking valve.However, this effect is negligible becauseblood located between the flaps of valves at the time of collapse, smoothes their mechanical interaction and prevents loud sounds.The main cause of the sound is a vibration of a tightly stretched valves immediately after their collapse and vibration of adjacent sections of the heart wall and the large vessels situated close to the heart.Thus, the first tone generation can be described as follows: initially ventricular contraction causes backflow of blood into the atrium to the location of A-B valves (mitral and tricuspid).The valves snap shut and bend toward the atria, while the tension of the tendon strands will not stop this movement.Elastic fibers and tendon tension valve leaflets reflects the flow of blood and sends it back to the side of the ventricles.This creates a vibration of the ventricular wall, sealed valves, as well as vibration and turbulent eddies in the blood.Vibration distributed adjacent tissue to the chest wall, where with the help of a stethoscope, these vibrations can be heard as the first heart sound.
second heart tone is the result of collapse semilunar valves at the end of ventricular systole.When the semilunar valves slam they bend under the pressure of the blood toward the ventricle, and are tightened and then the elastic recoil force abruptly shifted back toward the arteries.This causes transient turbulent blood flow between the arterial wall and semilunar valves and between the valves and the ventricular wall.The resulting vibration spreads then along the blood vessel by the surrounding tissue until the chest wall, where you can listen to the second heart sound.The duration of each heart sounds hardly more than 0.10 seconds: the first time is 0.14 seconds, and the second - 0.11 seconds.The duration of the second tone is shorter, becausesemilunar valves have a greater elastic tension than the A-B valves;their vibration continues for a short period of time.
systolic heart murmurs can occur for many reasons - for example:
- the valve does not close tightly, and there is a blood leak backward (regurgitation);
- blood passes through the narrowed heart valve or hard (so-called "stenosis").
There are several ways in which the doctor can describe heart sounds:
- noises are classified ( "score" given to them), depending on how the stethoscope sounds loud.Gradation - on a scale of 1 to 6;
- noise is described as a heartbeat, when the noise is heard.Heart murmurs can be described as systolic or diastolic.
When noise is more noticeable, the doctor may be able to feel it with his hand, attached to the heart.
doctor when viewed from the patient should take the following into consideration:
- Is there a noise when the heart is resting and it is infected;
- whether the last heartbeat;
- whether it is possible to change this when the patient moves;
- whether you can hear sounds in other parts of the chest and on the back or neck;
- which can be heard over the loud noise.
Causes of heart murmur
Many heart murmurs are harmless to human health.These types of noise are called "innocent noises."They do not cause any symptoms or problems, and do not require treatment.
Significant same noise can be caused by:
- aortic failure (the inability to complete the closure of the aortic valve, which occurs most often in men Many patients vice rheumatic nature usually associated with aortic stenosis and mitral defect To aortic insufficiency frequently causes... other causes of infective endocarditis "pure" aortic insufficiency - are: rheumatoid arthritis, and other syphilitic aortitis, ankylosing spondylitis, etc. Rarely defect is the result of trauma or congenital defect regarding aortic insufficiency may be accompanied by sclerosis and aortic aneurysm, Marfan syndrome... arterial hypertension causes incomplete closure of the return of the blood in the left ventricle from the aorta, leading to diastolic ventricular overload and to deficiency of peripheral blood circulation in patients may develop left ventricular, and later during diastole the aortic valve - right ventricular failure.This has an adverse effect on coronary circulation.Defect can progress as a result of the activity of the underlying disease or as a result of the gradual extension of aortic excess emissions);
- aortic stenosis (or aortic stenosis - is acquired or congenital narrowing of the orifice of the aorta through the merging of the leaflets of the aortic valve, which prevents the normal flow of blood from the left ventricle into the aorta, aortic stenosis -. A very common heart disease in adults Rheumatic aortic stenosis often.combined with mitral and aortic insufficiency. it is several times more common in men. Congenital aortic stenosis can often be associated with a bicuspid aortic valve, and is rarely associated with other malformations. The valve unit with aortic stenosis is prone to calcification, and this leads to further progression. stenosis in elderly patients with possible non-rheumatic calcific aortic stenosis In severe aortic stenosis there is an overload of the left ventricle, and the brain and the heart are suffering from a lack of blood supply to the expansion of the ascending aorta of different nature, more often -.. aneurysm of the ascending part of the aortic sclerosis, stretching of the aorta with aortic insufficiency orsevere hypertension - can lead to a relative aortic stenosis);
- hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic obstructive stenosis - most often this disease is defined as an expression of left ventricular hypertrophy with no apparent reason "Hypertrophic cardiomyopathy." - A more accurate term than "idiopathic hypertrophic subaortic obstructive stenosis", "hypertrophic obstructive cardiomyopathy"and "muscular subaortic stenosis" because not intended to include mandatory obstruction of the left ventricular outflow tract, which only occurs in 25% of cases. left ventricular hypertrophy is not secondary to hypertension and subaortic stenosis, as well as to disturbances of hemodynamics, which firstall affect the left ventricle);
- acute mitral regurgitation (or regurgitation - the rapid movement of liquids or gases arising in the hollow muscular organ in their reduction and reverse the normal direction of Most often this phenomenon occurs in violation of the functions of muscle zhomov or dividing walls, including -. Heart valves,or reverse movement of the waves of muscle contraction -. for example, when antistalsis stomach acute mitral regurgitation should be distinguished from reflux - passive wicking of liquids in the nearby area due to dysfunction of the separation media throwing by the esophagus stomach contents during its reduction -. gastro-esophageal regurgigatsiya. regurgitation in the cardiovascular system can occur in the heart, and in its vessels reason for regurgitation in heart -.. violation of the closing function of the tricuspid and mitral valves and aortic valves or pulmonary depending on which valves are amazed blood regurgitation occursin systole and diastole.In the phase of systole blood regurgitation into the left atrium occurs when the mitral valve and into the right atrium - appears when the tricuspid valve.There is a systolic murmur that can be heard at the mitral valve to the apex of the heart, with the tricuspid valve - right at the base of the xiphoid process of the sternum);
- chronic mitral regurgitation;
- mitral stenosis (or:. Mitral valve stenosis, the narrowing of the left atrioventricular opening - it is acquired, frequent, heart disease is characterized by generally narrowing atrioventricular openings, which leads to disruption of diastolic blood flow into the left ventricle from the left atrium stenosis mitral.the valve can sometimes be isolated, and can - combined with the defeat of the other valves and mitral valve insufficiency mitral stenosis is almost always the result of rheumatism, and often formed at a young age, and more - for women).;
- pulmonary regurgitation (arising as a result in pulmonary valve blood backflow failure right heart ventricle;.. Failure pulmonary valve, which causes the flow of blood from the pulmonary artery into the right ventricle during diastole most common cause - pulmonary arterial hypertension Pulmonary regurgitation oftenmost often asymptomatic, and it is a sign of decreasing diastolic murmur diagnosis is established by echocardiography usually no specific treatment is required, except for the therapeutic treatment of conditions that cause pulmonary hypertension)..;
- pulmonary artery stenosis (narrowing of the tract of the right ventricle in isolated pulmonary valve stenosis, pulmonary artery is 8-12% of all congenital heart defects In most cases this valve stenosis, but may also be combined -.. In combination with supravalvular and. subvalvular stenosis and other congenital heart defects congenital pulmonary stenosis occurs quite often characterized by complaints of patients with valvular stenosis of the pulmonary artery: shortness of breath, especially during physical activity, and in severe cases - even at rest, pain in the heart due to coronary deficiency.circulation and bluish lips);
- the tricuspid valve (or tricuspid, or aortic valve - a valve between the right atrium and right ventricle of the heart, which is represented by three connective plates that during systole of the right ventricle usually prevent blood regurgitation into the right atrium valve -. Of the heart, which is formedfolds the inner shell and provides a unidirectional flow of blood through the overlap of venous and arterial passageways. tricuspid aortic valve, located at the border of the left ventricle and the aorta, prevents backflow of blood from the aorta to the left ventricle during diastole. pulmonary valve located at the pulmonary artery exit. right ventricular It has three flaps that provide blood flow in only one direction in the pulmonary trunk);.
- stenosis of the tricuspid valve (or tricuspid stenosis - narrowing of the opening of the tricuspid valve, which hinders the flow of blood into the right ventricle from the right atrium most often happens as a result of rheumatic fever Symptoms: fatigue, discomfort fluttering sensations in the neck, cold skin, discomfort.in the upper right quadrant of the abdomen. Often it is visible pulsation of jugular veins in the fourth intercostal space on the left at the edge of the sternum can be heard presystolic noise that increases with inspiration. The diagnosis is established by echocardiography. stenosis of the tricuspid valve is usually benign, so when this diagnosis does not prescribe specifictherapy. In addition, for a number of patients can be an effective surgical intervention. stenosis is almost always accompanied by heart failure).
Causes of heart murmur in children
Heart murmurs in children are likely to be caused by:.
- anomalous venous return light (this is an abnormal formation of the pulmonary veins This defect is 2% of the total number of birthheart defects in children under the age of two years, with the pulmonary veins do not communicate with the left atrium, and the fall in the direct right atrium or connected with it through a large range of vein - azygos vein, the right superior vena cava, the left brachiocephalic trunk, ductus venosus and coronarysinus. also the pulmonary veins often merge into a single manifold extending beyond the left atrium, but not connected with it. The whole blood from the pulmonary veins normally returns to the right atrium where it is mixed with venous blood. Some of this blood then enters the left ventricle,the left atrium and the aorta; the remaining part comes through the right heart to the pulmonary vessels);.
- atrial septal defect (this is a common heart defect that is more common in women atrial septal defect «sinus venosus» are located in the upper part of the atrial septum, near the confluence of the superior vena cava, there is often detected and an abnormal falling of the right pulmonary veins.defects «ostium primum», on the contrary, are located at the bottom of the atrial septum, over the AV valves defects «ostium primum» -. an integral part of the AV channel - vice, which is very typical in Down syndrome and may include defects of AV septum defects low back department interventricularpartitions a single AV valve. defective «ostium secundum», the most common of the atrial septal defect, is usually at the center, at the site of the oval fossa. it differs from a patent foramen ovale, which is shortly after birth is closed and overgrown. in the case of speech defectis the absence of atrial septal tissue, leading to the discharge of blood, the value of which depends on the size of the defect, from the compliance of the ventricles, and the ratio of pulmonary vascular resistance.Most complaints come in 30-40 years: develop pulmonary hypertension, atrial fibrillation, bi-directional shunt, discharge from right to left, and heart failure);
- coarctation of the aorta (a congenital heart defect, segmental narrowing of the thoracic aorta distal to the left subclavian artery is manifested he segmental narrowing of the lumen of the aorta Coarctation of the aorta is 7.5% of all congenital malformations in newborns and early childhood Treatment -... Surgery.Defect occurs 2-4 times more frequently in men than in women appearance aortic coarctation can often resemble the shape of an hourglass narrowing in length -... from a few millimeters to 2-3 cm in place of coarctation of the aorta is usually the inner diameter is much smalleroutdoor At full coarctation of the aorta is completely impassable due to the diaphragm or narrowing of age, a child is most often the degree of aortic constriction increases When this vice there is hypertension above and below the aortic constriction is possible combination with other congenital heart defects -.... otkrytyv ventricular septal defect,arterial duct, aortic stenosis. patients adults can develop mitral insufficiency and aortic valves.The natural course of blemish often adverse - high mortality at 1-year life, and among the survivors decompensation 3-4 th decade of life);