Common systolic murmurs and their associated findings
THE CONTEXT
Management of additional heart sounds or murmurs depends on the underlying cause. Murmur characteristics and associated signs help distinguish common conditions.
Aortic stenosis
•
The murmur is mid-systolic, loud and rasping, heard at the base and left sternal border with radiation to the suprasternal notch and carotids.
•
Associated findings include a single second heart sound, an ejection click in young patients, a slow-rising pulse and left ventricular hypertrophy from pressure overload.
Mitral regurgitation
•
The murmur is pansystolic and blowing, heard at the apex with radiation to the axilla.
•
Associated findings include a soft first heart sound, a third heart sound and left ventricular hypertrophy from volume overload.
Ventricular septal defect
•
The murmur is pansystolic and harsh, heard at the lower left sternal border with radiation across the whole precordium.
•
Associated findings include a thrill and biventricular hypertrophy.
Benign systolic murmur
•
A benign murmur is mid-systolic and soft, heard at the left sternal border without radiation or other signs of heart disease.