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Systolic heart murmurs are heart murmurs heard during systole, [1] [2] [3] i.e. they begin and end between S1 and S2. Many involve stenosis of the semilunar valves or regurgitation of the atrioventricular valves .
The eponym is from researcher Samuel A. Levine who studied the significance of systolic heart murmurs. [1] The grading gives a number to the intensity from 1 to 6: [2] [3] The palpable murmur is known as thrill, which can be felt on grade 4 or higher. The murmur is only audible on listening carefully for some time.
Pulmonary valve stenosis is a crescendo-decrescendo systolic murmur. One can hear it best at the left upper sternal border. It has association with a systolic ejection click that increases with inspiration. This finding results from an increased venous return to the right side of the heart. Pulmonary stenosis sometimes radiates to the left ...
The first heart sound, or S 1, forms the "lub" of "lub-dub" and is composed of components M 1 (mitral valve closure) and T 1 (tricuspid valve closure). Normally M 1 precedes T 1 slightly. It is caused by the closure of the atrioventricular valves , i.e. tricuspid and mitral (bicuspid), at the beginning of ventricular contraction, or systole .
Patients with mitral valve prolapse may have a mid-systolic click along with a murmur, referred to as apical late systolic murmur. [3] Early systolic clicks may also be present in some patients. [4] Aortic and pulmonary stenosis may cause an ejection click [5] immediately after S 1.
Benign Paediatric Heart Murmurs; Name Location DDx; Still's murmur [4] inferior aspect of LLSB (lower left sternal border), systolic ejection sound, vibratory/musical quality subaortic stenosis, small VSD: Pulmonary ejection superior aspect of LLSB, ejection sound Pulmonary stenosis, atrial septal defect: Venous hum
Its duration is, as the name suggests, the whole of systole. The loudness of the murmur does not correlate well with the severity of regurgitation. It may be followed by a loud, palpable P 2, [6] heard best when lying on the left side. [7] A third heart sound is commonly heard. [6]
For example, a systolic ejection murmur, often accompanied by or without a systolic click, can be heard with a stethoscope. Patients may also feel tired easily (especially during physical activity), breathing difficulties (particularly during exertion), discomfort in the chest and lungs, and some individuals may also experience fainting episodes.
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