Holosystolic Murmur
Holosystolic Murmur - Related Videos
10:51
Cardiac Exam III: Abnormal Heart Sounds
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2023
Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center Having a fundamental understanding of normal heart sounds is the first step toward distinguishing the normal from the abnormal. Murmurs are sounds that represent turbulent and abnormal blood flow across a heart valve. They are caused either by stenosis (valve area too narrow) or regurgitation (backflow of blood across the valve) and are commonly heard as a "swishing" sound during auscultation.
06:24
Cardiac Exam II: Auscultation
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2023
Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center Proficiency in the use of a stethoscope to listen to heart sounds and the ability to differentiate between normal and abnormal heart sounds are essential skills for any physician. Correct placement of the stethoscope on the chest corresponds to the sound of cardiac valves closing. The heart has two main sounds: S1 and S2. The first heart sound (S1) occurs as the mitral and tricuspid valves...
08:10
Proper Adjustment of Patient Attire during the Physical Exam
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2023
Source: Jaideep S. Talwalkar, MD, and Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT In order to optimize the predictive value of the physical examination, the provider must perform maneuvers correctly. The proper use of drapes is an important component of correctly performing physical examination maneuvers. Skin lesions are missed when "inspection" occurs through clothing, crackles are erroneously reported when the lungs are examined through a...
20:06
The Comprehensive Infant Examination
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2023
Source: Heather Collette and Jaideep Talwalkar; Yale School of Medicine The newborn exam is important in establishing a baby's baseline health status as they enter the world. Newborn providers have the unique opportunity to evaluate a patient for the very first time. They are also tasked with identifying congenital anomalies that require early intervention to promote a long and healthy life for the child. Many newborn anomalies, such as heart defects, are noted on prenatal ultrasound. However,...
15:58
Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Organs
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2023
Source: Joseph H. Donroe, Rachel Liu; Yale School of Medicine, USA Point of care ultrasound (POCUS) is used by clinicians for diagnosis, ongoing monitoring, and/or procedural guidance at the time of patient care. Many medical schools are now teaching POCUS as a part of their basic clinical skills training, in addition to history, physical exams, and clinical reasoning. Besides being an independent skill, POCUS is also an incredibly useful tool for augmenting the teaching and learning of the...
FAQs
During ventricular contraction, a persistent pressure difference keeps blood moving turbulently rather than allowing flow to settle during systole. This sustained gradient accounts for the murmur’s relatively uniform intensity over that interval. The underlying abnormal pathway may be backward flow through an atrioventricular valve or flow across a ventricular septal defect, linking the sound to structural cardiac disease.
These conditions generate abnormal systolic flow through different anatomical routes. Mitral or tricuspid regurgitation reflects blood moving backward through an atrioventricular valve, whereas a ventricular septal defect permits flow between the ventricles. Because the source and direction of turbulent flow differ, clinicians interpret the murmur together with its location, radiation, quality, and other examination findings.
Assessment extends beyond timing and loudness. Clinicians note where the sound is best heard, whether it radiates, its acoustic quality, and whether intensity remains relatively uniform. These features help narrow the likely structural source and distinguish patterns associated with valve regurgitation from those associated with a ventricular septal defect, while supporting decisions about further cardiac evaluation.
Maneuvers that alter preload or afterload change the pressure and flow conditions acting on the heart. Observing how murmur intensity responds can therefore provide additional information about the hemodynamic mechanism producing the sound. This response is not interpreted in isolation; it complements auscultation and helps clinicians decide whether structural abnormalities should be investigated with echocardiography.
Evaluation begins with focused auscultation, including timing, location, radiation, quality, and intensity. Clinicians then consider the response to maneuvers that modify preload or afterload and relate those findings to possible structural causes. Echocardiographic assessment can follow when the examination suggests structural heart disease, providing a basis for estimating severity and planning ongoing care.
Echocardiography helps evaluate the structural abnormality suggested by the examination and supports estimation of its severity. In this context, it can clarify whether valve regurgitation or a ventricular septal defect is responsible for the abnormal flow pattern. The resulting information assists clinical decisions about monitoring and treatment rather than relying on sound characteristics alone.
Recognition is important when an examination may indicate structural heart disease rather than an isolated change in heart sound. Characterizing the murmur helps guide echocardiographic assessment, estimate the significance of the underlying abnormal flow, and determine whether monitoring or treatment is appropriate. Its clinical value comes from connecting bedside findings with decisions about cardiac evaluation and follow-up.