Such a phenomenon as systolic murmurs in the heart may not be familiar to everyone. Nevertheless, their presence deserves attention, since in most cases they appear against the background of the development of serious diseases. This is a kind of body signal, indicating that there are certain problems with the heart.
What do doctors mean by heart murmurs
Using a term such as “noise” in relation to the heart, cardiologists mean an acoustic phenomenon associated with a change in blood flow in the vessels and the heart itself. Among the inhabitants, one can find the opinion that noise in the heart is a problem characteristic of childhood. It is worth recognizing - this point of view is close to the truth, since more than 90% of cases of detection of functional noise are recorded in adolescents and children. But at the same time, systolic murmur was also diagnosed in young people aged 20 to 28 years.
The opinions of many cardiologists regarding heart murmurs in adults agree: a similar symptom indicates a specific cardiac pathology, which, in turn, gives grounds for a full-fledged cardiological study.
The term "systolic" has the most direct relation to the noises that are heard in the interval between the second and first cardiac sounds. Sounds themselves create blood flow near the heart or in its valves.
What types of noise can be found
In the medical environment, such a thing as heart murmurs is usually divided into several categories. This is a functional systolic murmur, 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 that are not related to the heart. This means that they are not a symptom of a pathological condition of the heart. According to the timbre, this type of noise is soft, unstable, musical, short, having a rather weak intensity. Such noises weaken as physical activity decreases and are not conducted outside the heart. The nature of their change is not associated with heart tones, but it directly depends on the position of the body.
As for organic noise, they arise due to a septal or valve defect (meaning a defect in the atrial or interventricular septum). The timbre of these noises can be characterized as persistent, hard, rough. In intensity they are sharp and loud, having a significant duration. This kind of noise is carried out outside the heart into the axillary and interscapular region. After physical exertion, organic noise is amplified and preserved. Also, they, unlike functional ones, are associated with heart tones and are equally clearly audible at different positions of the body.
Systolic murmur includes various types of acoustic phenomena in the region of the heart:
- early systolic murmurs;
- pansystolic (holosystolic);
- mid-late noises;
- systolic noise.
Why there are different kinds of noise in the heart
If you pay attention to significant noise, which should be perceived as a threat to health, it should be noted that they arise for several key reasons.
Systolic murmur in the heart may be due to aortic stenosis. This diagnosis should be understood as congenital or acquired narrowing of the aortic orifice, by fusion of the valves of the valve itself. This process makes the normal flow of blood within the heart problematic.
Aortic stenosis can be attributed to one of the most common heart defects found in adults. With this disease, aortic insufficiency and mitral defect often develop. Due to the fact that the aortic apparatus has a tendency to calcification (when stenosis progresses), the development of the disease increases.
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 that the aortic valve is not able to completely close. Aortic insufficiency itself often develops against the background of infectious endocarditis. Rheumatism (a large half of cases), systemic lupus erythematosus, syphilis and atherosclerosis can affect the development of this disease. In this case, the occurrence of this defect is extremely rarely lead to injuries or birth defects. Systolic murmur on the aorta may indicate the occurrence of relative aortic valve insufficiency. A sharp expansion of the fibrous ring of the valve and the aorta itself can lead to this condition.
Acute mitral regurgitation is another cause of systolic murmur. In this case, we are talking about the rapid movement of gases or liquids that occurs in hollow muscle organs in the process of their contraction. This movement has the opposite normal direction. Such a diagnosis in most cases is a consequence of dysfunction of the dividing walls.
Systolic murmur in the pulmonary artery indicates the development of stenosis in this area. With such a disease, a narrowing of the right ventricular tract occurs in the valve of the pulmonary artery . This type of stenosis accounts for approximately 8-12% of the total number of congenital heart defects. Such noise is always accompanied by systolic tremor. The irradiation of noise on the vessels of the neck is especially pronounced.
It is worth mentioning about stenosis of the tricuspid valve. With this disease, a narrowing of the tricuspid valve occurs. Such changes are most often the result of exposure to rheumatic fever. The 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
There are many factors that affect the work of the children's heart, but the following are more common than others:
- Atrial septal defect. A defect refers to the absence of atrial septal tissue leading to a discharge of blood. The amount of discharge directly depends on the compliance of the ventricles and the size of the defect itself.
- Abnormal venous return of the lungs. We are talking about the improper formation of pulmonary veins. More specifically, the pulmonary veins do not communicate with the right atrium, flowing immediately into the right atrium. It happens that they fuse with the atrium through the veins of the great circle (the right superior vena cava, unpaired vein, left brachiocephalic trunk, coronary sinus and venous duct).
- Coarctation of the aorta. Under this definition is congenital heart disease, in which segmental narrowing of the thoracic aorta occurs. In other words, the segmental lumen of the aorta becomes smaller. This problem is treated through surgery. If, with this diagnosis, no action is taken, then the narrowing of the aorta of the child will increase as it grows older.
- Ventricular septal defect. This problem is also one of the reasons why a systolic heart murmur is detected in a child. This defect is characterized in 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 part of other heart defects.
- Systolic heart murmur in a child may have causes associated with open arterial defect. It is a short vessel connecting the pulmonary artery and the descending aorta. The need for this physiological shunt disappears after the first breath of the baby, so 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 shunt from a large circle of blood circulation to a small one. If the duct is small, then, in principle, it will not have a significantly negative impact on the health status of the child. But when you have to deal with a large open ductus arteriosus, there is a risk of serious heart overload. Symptoms of this condition are frequent shortness of breath. If the duct is very large (9 mm or more), the newborn may be in an extremely serious condition. In this case, systolic murmur in children is not the only symptom - the heart itself will be significantly increased in size. An emergency operation is used to neutralize such a serious threat.
Separately, it is worth touching the category of newborns. The heart of children after birth is heard in the hospital. This is done to exclude possible pathologies. But if any noise was recorded, then do not make negative premature conclusions. The fact is that on average, every third child certain noise is detected. And not all of them are evidence of dangerous processes (they do not adversely affect the baby’s development and are not accompanied by circulatory disorders). It is during his (blood circulation) adjustment that functional noises in a child can arise, which also do not pose a threat to health. In this state, both radiographs and electrocardiograms will show the normal development of the heart in the baby.
As for congenital murmurs in infants, they are recorded during the first three months from birth. This diagnosis suggests that during intrauterine formation, the baby’s heart was not fully developed and, as a result, has certain congenital malformations. If the degree of influence of heart failure on the development of the baby will be too high, then perhaps the doctors will decide on a surgical procedure to eliminate the pathology.
Features of noise at 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 mitral regurgitation. In this case, the noise can be described as short. It appears early (protosystolic). With the help of echocardiography, zones of hypokinesis, rupture of chords, signs of bacterial endocarditis, etc. can be detected.
2. Chronic mitral regurgitation. Noises of this type completely occupy the period of contraction of the ventricles (holosystolic and pansystolic). There is a direct relationship between the size 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 defect progresses, then there will be a noticeable vibration of the chest wall during systole.
3. Relative mitral regurgitation. If you conduct a long examination (radiography, echocardiography), then it is possible to identify dilatation of the left ventricle. The systolic murmur at the apex in this case can persist throughout the entire period of ventricular contraction, but will be relatively quiet. If the symptoms of stagnation in heart failure are reduced, and adequate therapy is carried out, then the sonority of the noise will decrease.
4. Dysfunction of the papillary muscles. During the examination, signs of myocardial infarction or (and) ischemic disorders are often detected. Such systolic murmur at the apex of the heart can be characterized as variable. Moreover, it is characteristic for him to appear near the end of systole or in its middle part.
5. Mitral valve prolapse. It is possible a combination with late systolic murmur. This type is heard best in an upright position. Such noise, depending on the condition of the patient, can vary markedly. Such a systolic murmur at the apex is characterized by the manifestation in the middle part of 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:
- Ventricular septal defect. A noticeable trembling of the chest during the systole, to the left of the sternum. The size of the defect does not affect the noise characteristics. Heart hump is found in 100% of cases. A gross systolic murmur is recorded, which occupies the entire systole and is carried out in all departments. With the help of X-ray examination, dilatation of the aortic arch and pulmonary congestion can be detected.
- Congenital stenosis of the pulmonary artery. One of the main signs is a cat purr symptom. On examination, a cardiac hump (protrusion of the chest) is noticeable. The second tone above the pulmonary artery is weakened.
- Obstructive cardiomyopathy. Systolic murmur 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, it increases, while lying down, it subsides.
- Tetard Falao. These noises are distinguished by the presence of a combination of blood discharge from the left to 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 a fixation of systolic tremor. Noises are heard better at the lower point of the sternum. Using an ECG, you can fix the signs of hypertrophic changes in the right ventricle. But with the help of x-rays to identify pathology does not work. With any load, cyanosis appears.
Noises to the right of the sternum
In this place (II intercostal space) aortic malformations are heard. Noises in this area indicate acquired narrowing or having an innate genesis.
Such systolic murmur has certain features:
- the most advantageous place for its detection is 4 and 5 intercostal spaces to the left of the sternum;
- pensistolic, intense, rude and often scraping noise;
- carried out on the left side of the chest and reaches the back;
- in a sitting position the noise is amplified;
- X-ray examination fixes the expansion of the aorta, calcification of its valvular apparatus and an increase in the left ventricle;
- the pulse has poor filling and is also rare;
The progression of the defect leads to the expansion of the left arterioventricular opening. In this situation, there is a chance of listening to two different noises. If systolic murmur was caused by congenital stenosis, then there will be an additional tone of expulsion, which is due to concomitant aortic rugurgitation.
Cardiac murmurs during pregnancy
During the bearing of the child, systal murmurs may occur. Most often, they are functional in nature and are due to a sharp increase in the load on the heart of a pregnant woman. This condition is most characteristic of the third trimester. If the noise was recorded, then this is a signal to take the pregnant woman's condition (kidney function, load dosing, blood pressure) under close control.
If all these requirements are met exactly, then there is every chance that the pregnancy, as well as childbirth, will be positive, without negative consequences for the heart.
Noise diagnostics
The first thing that starts the process of diagnosing heart defects is to determine the absence or presence of noise in the heart. In this case, auscultation of the heart is carried out in horizontal and vertical position, after physical exertion, on the left side, as well as at the height of exhalation and inhalation. Such measures are necessary so that the systolic murmur in the heart, the causes of which can be completely different, is accurately identified.
If we talk about the defects of the mitral valve, the most optimal place to listen to noise in this case is the apex of the heart. In the case of aortic valve defects, pay attention to the third intercostal space to the left of the sternum or the second on the right side. If you have to deal with malformations of the tricuspid valve, then it is better to listen to systolic murmur in the lower edge of the sternum body.
Concerning the topic of noise characterization, it is worth noting the fact that they can have different phases (systolic and diastolic), duration, variability and conductivity. One of the key tasks at this stage is the accurate determination of one or more noise epicenters. It is also important to consider the timbre of noise, since this factor speaks about specific processes. If a slight systolic murmur does not portend serious problems, then a rough, sawing, scratching testifies to stenosis of the pulmonary aorta or the mouth of the aorta. In turn, blowing noise is recorded in infectious endocarditis and mitral regurgitation. The volume of tones above the base and the apex of the heart is also taken into account.
It is very important during diagnostic measures to initially exclude extracardiac murmurs, 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 heard during diastole.
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Even in the absence of visible heart problems or symptoms of any pathologies, it is necessary to undergo a periodic examination. Indeed, often the detection of systolic murmurs occurs by chance. Thus, periodic diagnosis is able to determine the presence of pathology at the stage when effective treatment is possible.