Murmurs
As with each valve there can be stenosis or regurgitation. Stenosis is where there is thickening or calcification of the valve so that it becomes stiff and will not open so easily. Regurgitation is where the valve can become damaged so that blood can leak back through it
Points to remember
- Murmurs are sounds that occur due to turbulence in the blood flow
- Although listening in the four areas [
] as previously described is of use in deciding which valve is responsible, sounds caused by valves (and pathology of the valves) is not limited to just those places
So if a murmur is heard listen elsewhere!
What to decide when you hear a murmur:
Can you hear it in systole or diastole?
Does the intensity (loudness) of the sound change throughout or is it constant?
What is the intensity of the murmur (see Levine scale below)?
Where (in time) does it occur in relation to S1 and S2?
Where on the chest is it loudest?
Does it radiate, and to where?
Levine grading scale:
I - heard only with special effort
II - soft but easily detected
III - prominent
IV- loud, sometimes with palpable thrill
