It’s important to consider three characteristics in relation to a murmur:
– Chronological location: systole or diastole
– Highest intensity spot
– Pitch
We determine the underlying pathology through these characteristics.
Mild mitral stenosis:
Mid- and telediastolic murmur of highest intensity at the apex of the heart. The patient must be auscultated in dorsal decubitus and in left lateral decubitus.
The auscultatory complex is as follows: accentuated first heart sound and opening snap.
Moderate to severe mitral stenosis:
In case of progression, the auscultatory complex would be: accentuated first heart sound, opening snap and rumbling mid-diastolic murmur. This murmur can be better heard with the patient in the left lateral decubitus position, placing the bell of the stethoscope very gently.
Mitral stenosis with sinus rhythm:
The total primary auscultatory complex of mitral stenosis in patients with sinus rhythm is as follows: accentuated first heart sound, opening snap, mid-diastolic murmur and presystolic murmur.
Mitral stenosis with atrial fibrillation:
The total primary auscultatory complex of mitral stenosis in patients with atrial fibrillation is as follows: accentuated first heart sound, opening snap and mid-diastolic murmur.
High-pitched systolic murmur loudestat the apex.
Grade 2 out of 6:
Grade 3 out of 6:
Grade 3 out of 6 with third heart sound:
It is a mitral stenosis combined with mitral regurgitation:
High-pitched systolic murmur loudest at the tricuspid point (xiphoid process).
It can vary during respiration, being louder during inspiration:
It is a harsh murmur that reaches its highest intensity at 2RICS and ends before the second heart sound.
It is a high-pitched, aspiration murmur that reaches its highest intensity at 3LICS ⎯Erb’s point:
In case of severe aortic regurgitation, a mid-diastolic murmur can be heard at the apex. This murmur is known as Austin-Flint:
It is an aortic stenosis combined with aortic regurgitation:
Continuous murmur heard at 2LICS.
It is also called machinery murmur because of its quality.
It is a holosystolic murmur, which can be better heard at the third or fourth left intercostal spaces.
It is sometimes common to hear a third sound at the apex due to the blood hyperflow passing through the mitral valve:
It consists of a systolic murmur loudest at 2LICS and a fixed split second sound:
It is a harsh systolic murmur loudest at 2LICS:
It is the friction between visceral and parietal pericardial layers. It can be heard more commonly between the apex and the sternum.
Its highest intensity is during inspiration:
Opinions of experts and students that have tried it.
CardioBeat is the tool every doctor should have on their phone.
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ValeriaStudent
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Dr. Guillermo BurilloEmergency physician
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María del CarmenCardiology nurse
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Dr. Néstor Báez FerrerCardiologist
I recommend CardioBeat to any medicine student and any physician who is on the front line to treat patients. This is a tool every doctor should have on their phone.
Dr. Sima Sami Fard Cardiologist
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Doctor Alberto Domínguez Rodríguez, clinical cardiologist in the cardiology department of the University Hospital of the Canary Islands (UHCI). I have designed a website to make the study of the heart sounds easier, besides helping professionals and students through aural examples that can only be heard through earphones, in order to offer them a better learning experience.
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