Systolic heart murmurs are characterized by
- Loudness:
- 1 / 6: Very quiet murmur, which can only be auscultated with difficulty
- 2 / 6: Quiet, but clearly audible
- 3 / 6: Loud heart murmur without buzzing
- 4 / 6: Loud murmur with murmur
- 5 / 6: Very loud heart murmur, audible immediately after placing the stethoscope on the patient's head
- 6 / 6: Loud murmur, which can be heard even without stethoscope
- Frequency
- Punctum maximum
- Conduction
- Position in relation to heart sounds
- Palpation of the carotid pulse
- Type of sound:
- Decrescendo-
- Spindle-
- Band-
- crescendo form (Herold 2022)
- Duration:
- holosystolic (sustained throughout systole)
- early or protosystolic
- late or telesystolic
- mid- or mesosystolic (Haas 2017)
This is an abnormal heart murmur occurring during systole.
Systolic murmurs are differentiated between:
- Ejection murmurs: Ejection murmurs result from obstruction between ventricles and great vessels.
- Regurgitant murmurs: These are caused by AV valve insufficiency, in which blood returns from the ventricles to the atria during systole.
- Ejection- click: This is a short early systolic high-frequency murmur that results from the opening of a pathologically altered semilunar valve (Haas 2017).
- Functional systolic heart murmurs:
Functional systolic heart murmurs are quiet, low-frequency murmurs. They are caused by flow phenomena due to increased stroke volume (Füeßl 2010) in e.g. anemia, fever, hyperthyroidism (Haas 2017), bradycardia, pregnancy (Herold 2022).
A functional systolic occurs after S1, is short-lived, and ceases before S2. The p. m. are apex, base or left parasternal (Attenhofer Jost 2004).
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Accidental systolic murmurs (also called Still'smurmur in infants):
These result from structural or hemodynamic changes in healthy hearts and are considered harmless. They are quiet, systolic murmurs that are parasternal auscultable in the 2nd / 3rd ICR and are not propagated (Füeßl 2010), never louder than 3 / 6 degrees (Haas 2017). The noise is probably due to vibrations of the pulmonary valve (Attenhofer Jost 2004).
- Continuous systolic-diastolic heart murmurs:
These are also called systolic-diastolic machine murmurs. They are caused by a vortex formation. If the vortex formation goes posteriorly, stenosis occurs; if it goes anteriorly, insufficiency occurs (Herold 2022).
These noise phenomena result from a shunt connection between the high and low pressure systems (Herold 2022).
A systolic click involves high-frequency oscillations, some of whose amplitude may exceed that of the 1st and 2nd heart sounds. It occurs in the middle or at the end of systole (Schmidt- Voigt 1982) and is found, for example, in mitral valve prolapse (Herold 2022).
So-called barnacle murmur is systolic-diastolic murmur occurring in children between 3 - 6 years of age due to turbulence in the jugular veins. Punctum maximum is located left or right infraclavicularly. The murmur is exclusively auscultable in the upright position and disappears when the head is turned (Haas 2017).