Such a phenomenon as systolic heart murmurs may not be familiar to everyone. Nevertheless, their presence deserves attention, since in most cases they appear against the background of the development of serious diseases. This is a kind of signal from the body, indicating that there are certain problems with the heart.
What doctors mean by heart murmurs
When using a term such as "murmurs" in relation to the heart, cardiologists mean an acoustic phenomenon associated with a change in blood flow in the vessels and the heart itself. Among the inhabitants, one can find the opinion that murmurs in the heart area are a problem characteristic of childhood. It is worth recognizing that such a point of view is close to the truth, since more than 90% of cases of functional noise detection are recorded in adolescents and children. But at the same time, systolic murmur was also diagnosed in young people aged 20 to 28.
Opinions of many cardiologists regarding heart murmurs in adults converge: such a symptom indicates a specific cardiac pathology, which, in turn, gives grounds for a full-fledged cardiological examination.
The term "systolic" is most directly related to the noises that are heard in the interval betweensecond and first heart sounds. The sounds themselves create blood flow near the heart or in its valves.
What types of noise can be found
In the medical environment, the phenomenon of heart murmurs is usually divided into several categories. This is a functional systolic murmur, the so-called innocent, and organic, the presence of which indicates a specific pathology.
Innocent murmurs have this name because they can be the result of various diseases not related to the heart. This means that they are not a symptom of a pathological condition of the heart. In terms of timbre, this type of noise is soft, inconstant, musical, short, having a rather weak intensity. Such murmurs weaken as physical activity decreases and are not conducted outside the heart. The nature of their change is not related to heart sounds, but it directly depends on the position of the body.
As for organic noise, they arise due to a septal or valvular defect (meaning atrial or ventricular septal defect). The timbre of these noises can be described as persistent, hard, rough. In intensity they are sharp and loud, having a considerable duration. This type of noise is conducted outside the heart into the axillary and interscapular regions. After exercise, organic noises are amplified and persist. Also, unlike functional ones, they are associated with heart sounds and are equally clearly audible in different body positions.
Systolic murmur includes different typesacoustic phenomena in the region of the heart:
- early systolic murmurs;
- pansystolic (holosystolic);
- mid-late noises;
- mid-systolic murmurs.
Why different kinds of murmurs occur in the heart
If you pay attention to significant noise that should be perceived as a threat to he alth, then it should be noted that they occur for several key reasons.
Systolic heart murmur may be due to aortic stenosis. This diagnosis should be understood as congenital or acquired narrowing of the aortic orifice, by means of fusion of the leaflets of the valve itself. This process makes normal blood flow within the heart problematic.
Aortic stenosis is one of the most common heart defects in adults. With this disease, aortic insufficiency and mitral valve disease often develop. Due to the fact that the aortic apparatus has a tendency to calcify (as stenosis progresses), the development of the disease increases.
In most cases, when serious aortic stenosis is recorded, the left ventricle is noticeably overloaded. At this time, the heart and brain begin to suffer from a lack of blood supply.
Aortic insufficiency can also be attributed to the reasons why systolic murmur develops. The essence of this disease is that the aortic valve is not able to close completely. Aortic insufficiency itself often develops against the background of an infectiousendocarditis. Rheumatism (more than half of cases), systemic lupus erythematosus, syphilis and atherosclerosis can influence the development of this disease. At the same time, injuries or congenital defects rarely lead to the occurrence of this defect. Systolic murmur on the aorta may indicate the occurrence of relative insufficiency of the aortic valve. This condition can lead to a sharp expansion of the fibrous ring of the valve and the aorta itself.
Acute mitral regurgitation is another cause of systolic murmurs. In this case, we are talking about the rapid movement of gases or liquids that occurs in the hollow muscular organs in the process of their contraction. This movement is in the opposite direction to the normal direction. Such a diagnosis in most cases is the result of a violation of the functions of the dividing partitions.
Systolic murmur in the pulmonary artery indicates the development of stenosis in this area. With such a disease in the pulmonary valve, a narrowing of the tract of the right ventricle occurs. This type of stenosis accounts for approximately 8-12% of all congenital heart defects. Such noise is always accompanied by systolic trembling. The irradiation of the noise to the vessels of the neck is especially pronounced.
Tricuspid valve stenosis is also worth mentioning. With this disease, the tricuspid valve narrows. Such changes are most often the result of exposure to rheumatic fever. Symptoms of this type of stenosis include cold skin,fatigue, discomfort in the upper right quadrant of the abdomen and neck.
Causes of systolic murmur in children
There are many factors that affect the functioning of a child's heart, but the following are more common than others:
- Atrial septal defect. A defect refers to the absence of atrial septal tissue, leading to a shunt of blood. The magnitude of the reset directly depends on the compliance of the ventricles and the size of the defect itself.
- Abnormal venous return of the lungs. We are talking about the incorrect formation of the pulmonary veins. More specifically, the pulmonary veins do not communicate with the right atrium, flowing directly into the right atrium. It happens that they fuse with the atrium through the veins of the great circle (right superior vena cava, unpaired vein, left brachiocephalic trunk, coronary sinus and ductus venosus).
- Coarctation of the aorta. Under this definition, a congenital heart disease is hidden, in which there is a segmental narrowing of the thoracic aorta. In other words, the segmental lumen of the aorta becomes smaller. This problem is treated through surgery. If no action is taken with this diagnosis, then the narrowing of the child's aorta will increase as they grow older.
- Ventricular septal defect. This problem is also one of the reasons why a systolic heart murmur is recorded in a child. This defect differs in that the defect develops between the two ventricles of the heart - the left and right. This heart defect is oftenfixed in an isolated state, although there are cases when a similar defect is part of other heart defects.
- Systolic heart murmur in a child may have causes associated with an open arterial defect. This is a short vessel that connects the pulmonary artery and the descending aorta. The need for this physiological shunt disappears after the first breath of the infant, so within a few days it closes on its own. But if this does not happen (which, in fact, is the essence of the defect), then the blood continues to shunt from the systemic circulation to the small one. If the duct is small, then, in principle, it will not have a significantly negative impact on the child's he alth. But when you have to deal with a large open ductus arteriosus, there is a risk of serious overload of the heart. Symptoms of this condition are frequent shortness of breath. If the duct is very large (9 mm or more), the newborn may be in an extremely serious condition. In this case, systolic murmur in children is not the only symptom - the heart itself will be significantly enlarged in size. To neutralize such a serious threat, an emergency operation is being used.
Separately, it is worth touching on the category of newborns. The heart of children after birth is tapped in the hospital. This is done to exclude possible pathologies. But if any noise was recorded, then you should not draw negative premature conclusions. The fact is that, on average, every third child has certain noises. And not all of them are evidencedangerous processes (do not have a negative impact on the development of the baby and are not accompanied by circulatory disorders). It is during its (blood circulation) restructuring that functional noises can occur in a child, which also do not pose a threat to he alth. In this state, both radiographs and electrocardiograms will show normal heart development in the infant.
As for congenital murmurs in infants, they are recorded within the first three months from birth. Such a diagnosis suggests that during intrauterine formation, the baby's heart was not fully developed and, as a result, has certain congenital malformations. If the degree of influence of heart failure on the development of the baby is too high, then perhaps the doctors will decide to perform a surgical intervention in order to eliminate the pathology.
Features of murmur at the apex of the heart
With this type of noise, the characteristics of the latter may vary depending on the cause and location.
1. Acute mitral valve insufficiency. In this case, the noise can be described as short-lived. It appears early (protosystolic). With the help of echocardiography, zones of hypokinesis, rupture of chords, signs of bacterial endocarditis, etc. can be detected.
2. Chronic insufficiency of the mitral valve. Noises of this type completely occupy the period of ventricular contraction (holosystolic and pansystolic). There is a direct relationship between the size of the valvular defect, the volume of blood returning through the defect, and the nature of the noise. Systolic murmur at the apex of the heart with these characteristics is best heard in a horizontal position. If the defect progresses, there will be a noticeable vibration of the chest wall during systole.
3. Relative mitral insufficiency. If a long-term examination (X-ray, echocardiography) is carried out, then dilatation of the left ventricle can be detected. The systolic murmur at the apex in this case may persist throughout the entire period of ventricular contraction, but will be relatively quiet. If the signs of congestion in heart failure decrease and adequate therapy is carried out, then the sonority of the murmurs will decrease.
4. Papillary muscle dysfunction. During the examination, signs of myocardial infarction and/or ischemic disorders are often detected. Such a systolic murmur at the apex of the heart can be characterized as variable. Moreover, it is characteristic to appear towards the end of systole or in its middle part.
5. Mitral valve prolapse. The combination with late systolic noise is not excluded. This type is heard best in an upright position. Such noises, depending on the patient's condition, can vary markedly. Such a systolic murmur at the apex is characterized by a manifestation in the middle part of the systole (the so-called mesosystolic click).
Noises to the left of the sternum (Botkin's point)
This type of noise has several causes:
- Ventricular septal defect. Trembling of the chest during systole is noticeable,to the left of the sternum. The size of the defect does not affect the noise characteristics. The heart hump is found in 100% of cases. A rough systolic murmur is recorded, which occupies the entire systole and is carried out to all departments. With the help of x-ray examination, dilatation of the aortic arch and plethora of the lungs can be detected.
- Congenital stenosis of the pulmonary artery. One of the main signs is a symptom of cat purring. On examination, a heart hump (protrusion of the chest) is noticeable. The second tone over the pulmonary artery is weakened.
- Obstructive cardiomyopathy. The systolic murmur at the Botkin point of this type is average and is able to change its intensity depending on the position of the body: if a person is standing, it increases, while lying down, it subsides.
- Tetard Falao. These murmurs are distinguished by the presence of a combination of shunting of blood from the left to the right chambers of the heart due to a defect in the septum between the ventricles and narrowing of the pulmonary artery. Such noise is rough, with fixation of systolic trembling. Noises are heard better at the lower point of the sternum. With the help of an ECG, signs of hypertrophic changes in the right ventricle can be recorded. But with the help of x-rays, pathology cannot be detected. With any load, cyanosis appears.
Noises to the right of the sternum
In this place (II intercostal space) aortic defects are heard. Noises in this area indicate an acquired narrowing or having a congenital genesis.
This systolic murmur has certain characteristics:
- the best place to find it -these are the 4th and 5th intercostal spaces to the left of the sternum;
- pensystolic, intense, rough and often scraping noise;
- is carried out along the left half of the chest and reaches the back;
- when sitting, the noise increases;
- X-ray examination fixes the expansion of the aorta, calcification of its valvular apparatus and an increase in the left ventricle;
- the pulse has poor filling and is also rare;
The progression of the defect leads to the expansion of the left arterioventricular orifice. In this situation, there is a possibility of listening to two different noises. If the systolic murmur was caused by congenital stenosis, then there will be an additional ejection tone that is due to concomitant aortic rugurgitation.
Heart Murmurs During Pregnancy
During childbearing, systolic murmurs may occur. Most often they are functional in nature and are due to a sharp increase in the load on the heart of a pregnant woman. This condition is most typical for the third trimester. If noises were recorded, then this is a signal to take the condition of the pregnant woman (kidney function, dosing of loads, blood pressure) under close control.
If all these requirements are strictly observed, then there is every chance that pregnancy, as well as childbirth, will be positive, without negative consequences for the heart.
Noise diagnostics
The first thing that begins the process of diagnosing heart defects isdetermination of the absence or presence of a heart murmur. In this case, auscultation of the heart is carried out in a horizontal and vertical position, after physical exertion, on the left side, as well as at the height of exhalation and inhalation. Such measures are necessary in order for the systolic heart murmur, the causes of which can be completely different, to be accurately identified.
If we talk about the defects of the mitral valve, then the most optimal place for listening to noises in this case is the apex of the heart. In the case of aortic valve defects, attention should be paid to the third intercostal space to the left of the sternum or the second to the right. If you have to deal with tricuspid valve defects, then it is better to listen to the systolic murmur in the lower edge of the body of the sternum.
Concerning the topic of noise characteristics, it is worth noting the fact that they can have different phases (systolic and diastolic), duration, variability and conductivity. One of the key tasks at this stage is to accurately determine one or more noise epicenters. It is also important to take into account the timbre of the noise, since this factor speaks of specific processes. If a slight systolic murmur does not portend serious problems, then a rough, sawing, scraping one indicates stenosis of the pulmonary aorta or the aortic mouth. In turn, blowing noise is recorded in infective endocarditis and mitral insufficiency. The volume of tones above the base and apex of the heart is also taken into account.
It is very important during diagnostic measures to initially exclude non-cardiac murmurs, that is, the source of whichis outside the heart. In most cases, such noises can be heard with pericarditis. But such acoustic phenomena are determined only during the period of systole. As an exception, they can be heard during diastole.
Different technologies are used to diagnose the condition of the heart. Their application is necessary, since the conclusions drawn on the basis of the obtained physical data need to be confirmed. To achieve this goal, specialists use FCG, ECG, chest x-ray in three projections, echocardiography, including transesophageal.
As an exception for strict indications, invasive diagnostic methods (probing, contrast methods, etc.) are used.
Specific probes are used to measure the intensity of heart murmurs:
- physical activity (isometric, isotonic and carpal dynamometry);
- breathing (increased murmurs from the left and right parts of the heart on exhalation)
- atrial fibrillation and extrasystole;
- positional changes (lifting the legs in a standing position, changing the position of the patient's body and squats);
- Valsalva test (fixing the breath with the mouth and nose closed), etc.
Key Findings
First of all, it is important to understand the relevance of modern diagnostics in the presence of heart murmurs. Its necessity is explained by the fact that systolic murmur may not portend tangible he alth problems, but at the same time it can be a manifestation of a serious illness.
Therefore, any noise,which was found in the heart, must be explained by qualified doctors (it is necessary to correctly and accurately determine the cause). In fact, heart murmurs always have individual characteristics associated with age periods. Any noise in the region of the heart deserves the attention of a doctor. The occurrence of a heart murmur in a pregnant woman is sufficient reason to establish constant monitoring of her condition.
Even in the absence of visible heart problems or symptoms of any pathologies, it is necessary to periodically undergo an examination. Indeed, often the detection of systolic murmurs occurs by chance. Thus, periodic diagnosis is able to determine the presence of pathology at the stage when effective treatment is possible.
