Systolic heart murmur

Such a phenomenon as systolic murmurs in the heart may not be familiar to everyone. Nevertheless, their presence deserves attention, since they in most cases appear against the background of the development of serious diseases. This is a kind of signal of the body, which indicates that there are certain problems with the heart.

What do doctors mean under the noises in the heart

Using a term such as "noise" in relation to the heart, cardiologists mean an acoustic phenomenon associated with changes in blood flow in the vessels and the heart itself. Among the townsfolk one can find the opinion that noises in the heart area are a problem characteristic of childhood. Admittedly, this viewpoint 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 diagnosed among young people aged 20 to 28 years.

The opinions of many cardiologists regarding heart murmurs in adult people converge: a similar symptom indicates a specific cardiac pathology, which in turn gives grounds for a full cardiac study.

The term "systolic" is most relevant to the noise that is heard in the interval between the second and the first heart tones. The sounds themselves create blood flow near the heart or in its valves.

What kinds of noise can be found

In a medical environment, such a phenomenon as noise in the heart, it is common to divide into several categories. This is a functional systolic noise, the so-called innocent, and organic, the presence of which indicates a specific pathology.

Innocent noises 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 the pathological condition of the heart. By the timbre, this kind of noise is soft, unstable, musical, short, having a sufficiently weak intensity. Such noise is weakened as the exercise is reduced and is not carried out beyond the heart. The nature of their changes is not related to heart tones, but it directly depends on the position of the body.

As for organic noise, they arise because of a septal or valvular defect (meaning an atrial or interventricular septal defect). The timbre of these noises can be characterized as staunch, hard, rough. In intensity they are sharp and loud, having a considerable duration. This type of noise is carried out beyond the heart in the armpit and interscapular area. After physical exertion, organic noise is amplified and preserved. Also, unlike functional ones, they are associated with heart tones and are equally distinctly audible at different positions of the body.

Systolic murmur includes various types of acoustic phenomena in the heart:

- early systolic murmur;

- Pansystolic (holosystolic);

- medium-late noise;

- Mean systolic murmur.

Why in the heart there are different kinds of noise

If you pay attention to significant noise that should be taken as a threat to health, then it should be noted that they arise for several key reasons.

Systolic murmur in the heart may be a consequence of aortic stenosis. Under this diagnosis, one must understand the congenital or acquired constriction of the aortic aperture, by splicing the valves of the valve itself. This process makes normal blood flow inside the heart problematic.

Aortic stenosis can be attributed to one of the most common heart defects that occur in adults. With this disease, aortic insufficiency and mitral defect often develop. Due to the fact that the aortic apparatus is prone to calcification (when stenosis progresses), the development of the disease is intensified.

In most cases, when a serious aortic stenosis is fixed, the left ventricle is significantly 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 reduced to the fact that the aortic valve is not able to completely close. Aortic insufficiency itself often develops against the background of infective endocarditis. Influence on the development of this disease can rheumatism (more than half the cases), systemic lupus erythematosus, syphilis and atherosclerosis. In this case, the occurrence of this blemish is very rarely caused by trauma or birth defects. Systolic murmur on the aorta may indicate the occurrence of a relative aortic valve failure. To such a state is able to lead a sharp expansion of the fibrous valve ring and the aorta itself.

Acute mitral regurgitation is another cause of systolic noises. In this case, we are talking about the rapid movement of gases or liquids, which occurs in the hollow muscular organs in the process of their contraction. Such a motion has the opposite of the normal direction. Such a diagnosis in most cases is a consequence of the violation of the functions of dividing partitions.

Systolic murmur on the pulmonary artery indicates the development of stenosis in this area. With such a disease in the valve of the pulmonary artery, the right ventricular tract is narrowing. This type of stenosis is approximately 8-12% of the total number of congenital heart defects. This noise is always accompanied by systolic trembling. Particularly pronounced is the irradiation of noise on the vessels of the neck.

Mention should also be made of the stenosis of the tricuspid valve. With this disease, the tricuspid valve is narrowed. Such changes are most often the result of 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

Factors that affect the work of the child's heart, a lot, but more often than others there are the following:

- Atrial septal defect. Defect refers to the absence of the tissue of the interatrial septum leading to a discharge of blood. The magnitude of the discharge directly depends on the compliance of the ventricles and the size of the defect itself.

- Abnormal venous return of the lungs. It is a question of incorrect formation of pulmonary veins. More specifically, pulmonary veins do not communicate with the right atrium, immediately flowing into the right atrium. It happens that they fuse with the atrium through the veins of a large circle (right upper hollow vein, unpaired vein, left brachiocephalic trunk, coronary sinus and venous duct).

- Coarctation of the aorta. Under this definition, congenital heart disease, in which segmental narrowing of the thoracic aorta occurs , disappears. In other words, the segmental aortic lumen becomes smaller. This problem is treated through surgical intervention. If you do not take any actions with this diagnosis, the aortic narrowing of the child will increase as you grow up.

- Defect of interventricular septum. This problem is also one of the reasons why systolic murmur in the heart of a child is recorded. This defect is characterized by the fact that the defect develops between the two ventricles of the heart - left and right. Such a heart defect is often fixed in an isolated state, although there are cases when such a defect is a part of other heart defects.

- A systolic murmur in the heart of a child can have a cause, associated with an open arterial blemish. 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 baby, therefore 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 be shunted from the large circle of blood circulation to the small one. If the duct is small, then, in principle, it will not have a significant negative impact on the health of the child. But when one has to deal with a large open arterial duct, there is a risk of a serious heart overload. Symptoms of this condition are frequent shortness of breath. If the duct is very large (9 mm or more), the newborn can be in extremely serious condition. In this case, systolic murmur in children is not the only symptom - the heart itself will be greatly increased in size. An emergency operation is used to neutralize such a serious threat.

Separately, it is worth mentioning the category of newborns. The heart of children after birth is listened to in the hospital. This is done to exclude possible pathologies. But if any noise was detected, then it is not necessary to make negative premature conclusions. The fact is that on average every third child has certain noises. And not all of them are evidence of dangerous processes (do not have a negative impact on the development of the baby and are not accompanied by a violation of blood circulation). It is during his (blood circulation) adjustment that functional noise in the child can arise, which also do not pose a threat to health. In this state, both radiographs and electrocardiograms will show normal development of the heart in the infant.

With regard to congenital noise in infants, they are recorded within the first three months of birth. Such a diagnosis suggests that during the intrauterine formation the baby's heart was not fully developed and, as a consequence, 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 to eliminate the pathology.

Features of noise in the apex of the heart

With this type of noise, the characteristics of the latter can vary depending on the cause and place of occurrence.

1. Acute insufficiency of the mitral valve. In this case, the noise can be characterized as a short one. He appears early (protosystolic). With the help of echocardiography, areas of hypokinesia, rupture of chords, signs of bacterial endocarditis, etc. can be identified.

2. Chronic insufficiency of the mitral valve. Noises of this type completely occupy the period of contraction of the ventricles (holosystolic and pansystolic). There is a direct relationship between the magnitude of the valve defect, the volume returned through the blood 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 malformation progresses, there will be a perceptible vibration of the chest wall during systole.

3. Relative mitral insufficiency. If you carry out a long examination (radiography, echocardiography), then you can identify dilatation of the left ventricle. Systolic murmur at the tip in this case can persist throughout the period of contraction of the ventricles, but will be relatively quiet. If signs of stagnation in heart failure decrease, and adequate therapy is conducted, then the sonority of the noise will decrease.

4. Dysfunction of papillary muscles. During the examination, there are often signs of myocardial infarction or (and) ischemic disturbances. Such systolic murmur at the apex of the heart can be characterized as changeable. Moreover, it is characteristic for him to appear near the end of the systole or in its middle part.

5. Mitral valve prolapse. The combination with late systolic noise is not excluded. Listened to this type is best in an upright position. Such noise can vary considerably depending on the patient's condition. Such systolic murmur at the apex is characterized by the manifestation in the middle part of the systole (the so-called mesosystolic click).

Noises to the left of the sternum (Botkin's point)

There are several reasons for this type of noise:

- Defect of interventricular septum. Noticeably, the tremor of the chest during the systole, to the left of the sternum. The size of the defect does not influence the noise characteristics. Heart hump is found in 100% of cases. A coarse systolic murmur is fixed, which occupies the entire systole and is conducted to all departments. With the help of X-ray study, dilatation of the arch of the aorta 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, the cardiac hump (bulging of the chest) is noticeable. The second tone above the pulmonary artery is weakened.

- Obstructive cardiomyopathy. Systolic noise 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 stands, increases, while in a lying position, it subsides.

- Tetard Falao. These noises are distinguished by the presence of a combination of discharge of blood from the left into 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 coarse, with fixation of systolic jitter. Noises are tapped better at the bottom of the sternum. With the help of ECG, you can record signs of hypertrophic changes in the right ventricle. But with the help of X-ray images, it is not possible to detect pathology. At 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 a acquired constriction or having an innate genesis.

Such systolic noise has certain characteristics:

- The most advantageous place for its detection is the 4 and 5 intercostal spaces to the left of the sternum;

- retired, intense, rough and often scraping noise;

- is carried out on the left side of the thorax and reaches the back;

- in the sitting position, the noise increases;

- X-ray examination fixes the aorta expansion, calcification of its valvular apparatus and an increase in the left ventricle;

- the pulse has a poor filling and is also rare;

Progression of the lesion leads to an expansion of the left arterio-ventricular orifice. In this situation, there is a possibility of listening to two different noises. If the systolic murmur was triggered by congenital stenosis, then there will be an additional tone of exile, which is due to concomitant aortic regurgitation.

Heart murmurs during pregnancy

During the child's birth, systalic noise may occur. Most often they have a functional character and are caused by a sharp increased load on the heart of a pregnant woman. This condition is most typical for the third trimester. If the noise was recorded, then this is a signal to take the pregnant state (kidney work, dosing of loads, blood pressure) under close supervision.

If all these requirements are met exactly, then there are all chances that pregnancy, as well as childbirth, will pass positively, without negative consequences for the heart.

Noise Diagnosis

The first thing that begins the process of diagnosing heart defects is the determination of the absence or presence of noises in the heart. In this case, auscultation of the heart is carried out in a horizontal and vertical position, after physical exertion, on the left side, and also at the height of exhalation and inspiration. Such measures are necessary to ensure that the systolic murmur in the heart, whose causes can be completely different, has been accurately identified.

If we talk about the defects of the mitral valve, then the best place to listen to the noise in this case is the tip 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 the flaws of the tricuspid valve, then you should hear the systolic murmur better in the lower edge of the sternum body.

Concerning the topic of noise characteristics, it is worth noting the fact that they can have different phase (systolic and diastolic), duration, variability and conductivity. One of the key tasks at this stage is the precise definition of one or more noise epicenters. It is also important to consider the timbre of noise, since this factor indicates specific processes. If mild systolic murmur does not foretell serious problems, then the rough, sawing, scraping testifies to the stenosis of the pulmonary aorta or the aortic aorta. In turn, blowing noise is fixed in case of infective endocarditis and mitral insufficiency. The loudness of the tones over the base and the tip of the heart is taken into account.

It is very important during the diagnostic activities to initially exclude out-of-cardiac noise, that is, the source of which is outside the heart. In most cases, such noises can be heard with pericarditis. But such acoustic phenomena are determined only during the systole period. As an exception, they can be listened to during diastole.

Various 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 the FCG, ECG, radiograph of the heart in three projections, echocardiography, including transesophageal.

As an exception, with strict indications, invasive diagnostic methods (sounding, contrast methods, etc.) are used.

To measure the intensity of cardiac noise, certain samples are used:

- physical load (isometric, isotonic and carpal dynamometry);

- breathing (increase in noise from the left and right parts of the heart on exhalation)

- Atrial fibrillation and extrasystole;

- positional changes (lifting legs in standing position, changing the position of the patient's body and squats);

- Valsalva test (fixation of breathing with closed mouth and nose), etc.

Key findings

First of all, it is important to understand the relevance of modern diagnostics in the presence of noise in the heart. Its necessity is explained by the fact that systolic murmur can not foretell tangible health problems, but at the same time it can be a manifestation of a serious disease.

Therefore, any noise that was detected in the heart should be explained by qualified physicians (it is necessary to determine the cause correctly and accurately). In fact, always heart murmurs have individual characteristics associated with age periods. Any noise in the heart area deserves the doctor's attention. The occurrence of heart murmurs in a pregnant woman is a sufficient reason to establish a constant control over her condition.

Even in the absence of visible problems with the heart or the symptoms of any pathology, it is necessary to undergo periodic examination. After all, often the detection of systolic noises occurs by chance. Thus, periodic diagnosis can determine the presence of pathology at the stage where effective treatment is possible.