cardiac murmur

• 心雑音

関

diastolic murmur、heart murmur

WordNet

1. speak softly or indistinctly; "She murmured softly to the baby in her arms"
2. make complaining remarks or noises under ones breath; "she grumbles when she feels overworked" (同)mutter, grumble, croak, gnarl
3. of or relating to the heart; "cardiac arrest"
4. making a low continuous indistinct sound; "like murmuring waves"; "susurrant voices" (同)susurrant, whispering
5. the opening into the stomach and that part of the stomach connected to the esophagus

PrepTutorEJDIC

1. (流れる水・そよぐ葉などの)『ざわるき』,かすかな音;(人の声の)『ささやき』,ぼそぼそいう声《+『of』+『名』》 / 不平の声,ぶつぶつ言うこと / 〈川・風・木の葉などが〉『ざわめく』 / 〈人が〉『ささやく』,つぶやく / 《まれ》(…について)ぶつぶつ不平を言う《+『at』(『against, about』)+『名』》 / …‘を'『ささやく』,ぼそぼそと言う,小声で言う
2. 心臓の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/16 07:48:29」(JST)

wiki en

[Wiki en表示]

Cardiac murmurs and other cardiac sounds

Auscultogram from normal and abnormal heart sounds
ICD-10	R01
ICD-9	785.2-785.3
DiseasesDB	29151
MedlinePlus	003266
MeSH	D006337

Murmurs are pathologic heart sounds that are produced as a result of turbulent blood flow that is sufficient to produce audible noise. Most murmurs can only be heard with the assistance of a stethoscope ("on auscultation").

A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart, as opposed to structural defects in the heart itself. Functional murmurs are benign (an "innocent murmur").

Murmurs may also be the result of various problems, such as narrowing or leaking of valves, or the presence of abnormal passages through which blood flows in or near the heart. Such murmurs, known as pathologic murmurs, should be evaluated by an expert.

Heart murmurs are most frequently categorized by timing, into systolic heart murmurs and diastolic heart murmurs. However, continuous murmurs cannot be directly placed into either category.

Classification

Murmurs can be classified by seven different characteristics: timing, shape, location, radiation, intensity, pitch and quality.

• Timing refers to whether the murmur is a systolic or diastolic murmur.
• Shape refers to the intensity over time; murmurs can be crescendo, decrescendo or crescendo-decrescendo.
• Location refers to where the heart murmur is usually auscultated best. There are six places on the anterior chest to listen for heart murmurs; each of the locations roughly corresponds to a specific part of the heart. The first five of the six locations are adjacent to the sternum. The six locations are:
  • the 2nd right intercostal space
  • the 2nd to 5th left intercostal spaces
  • the 5th left mid-clavicular intercostal space.
• Radiation refers to where the sound of the murmur radiates. The general rule of thumb is that the sound radiates in the direction of the blood flow.
• Intensity refers to the loudness of the murmur, and is graded according to the Levine scale, from 1 to 6:
  • 1: The murmur is only audible on listening carefully for some time.
  • 2: The murmur is faint but immediately audible on placing the stethoscope on the chest.
  • 3: A loud murmur readily audible but with no palpable thrill.
  • 4: A loud murmur with a palpable thrill.
  • 5: A loud murmur with a palpable thrill. The murmur is so loud that it is audible with only the rim of the stethoscope touching the chest.
  • 6: A loud murmur with a palpable thrill. The murmur is audible with the stethoscope not touching the chest but lifted just off it.
• Pitch may be low, medium or high and is determined by whether it can be auscultated best with the bell or diaphragm of a stethoscope.
• Quality refers to unusual characteristics of a murmur, such as blowing, harsh, rumbling or musical.

The use of two simple mnemonics may help differentiate systolic and diastolic murmurs; PASS and PAID. Pulmonary and aortic stenoses are systolic while pulmonary and aortic insufficiencies (regurgitation) are diastolic. Mitral and tricuspid defects are opposite.

Interventions that change murmur sounds

• Inhalation leads to drop in intrathoracic pressure, which increases the capacity of pulmonary circulation, thereby prolonging ejection time. This will affect the closure of the pulmonary valve. This finding, also called Carvallo's maneuver, has been found by studies to have a sensitivity of 100% and a specificity of 80% to 88% in detecting murmurs originating in the right heart. specifically positive Carvallo's sign describes the increase in intensity of a tricuspid regurgitation murmur with inspiration.
• abrupt standing
• Squatting, by increasing preload
• Handgrip maneuver, by increasing afterload
• Valsalva maneuver. One study found the Valsalva maneuver to have a sensitivity of 65%, specificity of 96% in detecting hypertrophic obstructive cardiomyopathy (HOCM). Both standing and Valsalva maneuver will decrease venous return and subsequently decrease left ventricular filling, resulting in an increase in the loudness of the murmur of hypertrophic cardiomyopathy, since outflow obstruction is increased by decreasing preload. Alternatively, squatting increases venous return and thus decreases the murmur. Maximum handgrip exercise also results in a decreased loudness of the murmur.
• post ectopic potentiation
• amyl nitrite
• methoxamine
• positioning of the patient. That is, putting patients in the left lateral position will allow a murmur in the mitral valve area to be more pronounced.

Examples of anatomic source of murmur

Stenosis of Bicuspid aortic valve

Symptoms tend to present between 40 and 70 years of age.

Stenosis of Tricuspid Aortic Valve

Symptoms more likely to present after 80 years of age.

Hypertrophic subaortic stenosis

Symptoms are a harsh murmur in mid-systole, often accompanied by S4, Brisk Bifid Carotid upstroke. Murmur increases with standing and valsalva maneuver.

Ventricular septal defect, rooseter sounds

Symptoms are holosystolic, heard best at left lower sternal border.

Cooing dove murmur

The cooing dove murmur is a cardiac murmur with a musical quality (high pitched - hence the name) and is associated with acute mitral valve regurgitation, preceded by a rupture of the chordae tendinea (the fibrous "strings" that connect the papillary muscle to the cusps of the valves). It is a systolic murmur which is best heard over the left second, third and fourth intercostal spaces.

See also

• Benign paediatric heart murmur
• Precordial examination

References

External links

• Information on heart murmurs in children from Seattle Children's Heart Center
• Heart Murmurs in Pediatric Patients
• Lehrer, Steven. Understanding Pediatric Heart Sounds. Elsevier 2002.
• Hanifin, Christopher. Heart Sounds: A Cardiac Auscultation Primer. CreateSpace, 2010
• Texas Heart Institute Scroll down to listen to heart murmurs.
• The Auscultation Assistant Provides recordings of heart murmurs.
• Heart murmurs in children information for parents.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 心雑音の聴診 auscultation of cardiac murmurs
• 2. 幼児および小児における心疾患の疑い：紹介の基準 suspected heart disease in infants and children criteria for referral
• 3. 心雑音および心音の鑑別診断における生理学的および薬理学的手法 physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds
• 4. 幼児および小児における孤立性心室中隔欠損の病態生理および臨床的特徴 pathophysiology and clinical features of isolated ventricular septal defects in infants and children
• 5. 新生児における先天性心疾患（CHD）：重症ＣＨＤの症状およびスクリーニング congenital heart disease chd in the newborn presentation and screening for critical chd

English Journal

• A modular approach to computer-aided auscultation: Analysis and parametric characterization of murmur acoustic qualities.

• Shen CH, Choy FK, Chen Y, Wang S.SourceDepartment of Mechanical Engineering, Chang Gung University, Guishan Taoyuan 333, Taiwan, ROC. Electronic address: p.c.shen@gmail.com.
• Computers in biology and medicine.Comput Biol Med.2013 Jul 1;43(6):798-805. doi: 10.1016/j.compbiomed.2013.01.008. Epub 2013 May 1.
• In the present work, a modularized approach to computer-aided auscultation based on the traditional cardiac auscultation of murmur is proposed. Under such an approach, the present paper concerns the task of evaluating murmur acoustic quality character. The murmurs were analyzed in their time-series
• PMID 23668356

• Aneurysmal coronary cameral fistula.

• Jamil G, Khan A, Malik A, Qureshi A.SourceDepartment of Medicine, Division of Cardiology, Tawam Hospital, Al Ain, United Arab Emirates.
• BMJ case reports.BMJ Case Rep.2013 Jun 3;2013. pii: bcr2013008649. doi: 10.1136/bcr-2013-008649.
• A 26-year-old asymptomatic man, being medically managed for ventricular septal defect since childhood, presented to the outpatient clinic for a second opinion. Clinically, he was well built with normal vital signs. Cardiac auscultation was significant for a diastolic murmur over the praecordium. An
• PMID 23737570

• Anomalous origin of the left coronary artery from the pulmonary artery confirmed by 320-slice computed tomography.

• Zhu J, Liu Y, Zhu SB, Zhang Y.SourceDepartment of Thoracic Cardiovascular Surgery, Wuhan General Hospital of Guangzhou Command, 627#, Wuluo Road, Wuchangqu, Wuhan, 430070, Hubei, People's Republic of China, zhujian0718@163.com.
• Pediatric cardiology.Pediatr Cardiol.2013 Jun;34(5):1283-4. doi: 10.1007/s00246-012-0594-z. Epub 2012 Nov 22.
• Anomalous origin the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare congenital coronary abnormality that may be difficult to diagnose by echocardiography. Most patients present with a potentially fatal illness leading to sudden cardiac death during infancy. This report
• PMID 23179429

Japanese Journal

• Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus

• , , , , ,
• Journal of Veterinary Medical Science 77(3), 331-336, 2015
• … Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously. … A continuous murmur with maximal intensity over the left heart base (Levine 5/6) was detected on auscultation. …
• NAID 130005060994

• Careful Auscultation after Detection of Bacteremia Leading to a Diagnosis of Patent Ductus Arteriosus in Adult

• , , , , , ,
• General Medicine 15(2), 143-147, 2014
• … In addition to her history of dental calculus removal, careful cardiac auscultation revealed a continuous murmur, leading to the existence of patent ductus arteriosus (PDA). …
• NAID 130004935088

• Peripheral pulmonary artery stenosis in three cats

• , , , , ,
• Journal of Veterinary Medical Science advpub(0), 2014
• … Case 1 involved a 4-month-old intact male Somali cat in which peripheral pulmonary artery stenosis (PPS) was recognized after a cardiac murmur remained following patent ductus arteriosus ligation. … Case 2, which involved a 1-year-old neutered male Norwegian Forest cat, and Case 3, which involved a 6-month-old intact female American Curl cat, were referred, because of cardiac murmurs. …
• NAID 130004781053

Related Links

• Cardiac Murmur | Listen and Stream Free Music, Albums ...

Cardiac Murmur's profile including the latest music, albums, songs, music videos and more updates.

• Cardiac murmur | Define Cardiac murmur at Dictionary.com

Cardiac murmur definition at Dictionary.com, a free online dictionary with pronunciation, synonyms and translation. Look it up now! Added to Favorites Dictionary Thesaurus Word Dynamo Quotes Reference Translator Spanish n. ...

Related Pictures

---

★リンクテーブル★

リンク元	「心雑音」
関連記事	「cardiac」

「心雑音」

　　[★]

英

heart murmur, cardiac murmur

関

拡張期雑音、過剰心音、レヴァイン分類

収縮期雑音 systolic murmur

• A. 駆出性　　：ダイアモンド型：大動脈弁狭窄症 AS, 肺動脈弁狭窄症 PS
• B. 汎収縮期　：pansystolic/holosystolic：僧帽弁閉鎖不全症、三尖弁閉鎖不全症、心室中隔欠損
• C. 収縮期末期：click音を伴う：僧帽弁逸脱症

拡張期雑音 diastolic murmur

• A. 早期　　　：逆流性：decrescendo：大動脈弁閉鎖不全症 AR、肺動脈弁閉鎖不全症 PR
• B. 中期～末期：　　　：OS+decrecendo+crecendo：僧帽弁狭窄症 MS、三尖弁狭窄症 TS

continuous murmur

• 連続的な圧較差の存在を示唆する
• A. continuous：動脈管開存症 PDA：肺動脈弁領域。動脈管を流れる血流と雑音が比例するので、S2に向かって大きくなり、S1に向かって小さくなる。
• B. to-and-fro: AS + AR, PS+ PR　：S1～(収縮期：AS,PSによる駆出性雑音。ダイアモンド型)～S2, S2～(拡張期：MR,PRによる逆流性雑音。decrescendo)～S1　S1に向かって小さくなるので、連続音とは区別できるはず。

手技見えp.116

• 僧帽弁開放音(OS)：MS
• 収縮中期クリック：MVP
• 拡張期ランブル　＋　前収縮期雑音：MS
• 拡張期灌水様雑音/拡張期逆流性雑音：AR、PR
• 収縮期逆流性雑音：心尖部：MR

体位との関係

	胸壁に近づく部位
左側臥位	心尖部	僧帽弁雑音(MR,MS)、僧帽弁開放音(OS)、III音、IV音
座位前屈位	大動脈弁領域	大動脈弁閉鎖不全症(AR)
肘膝位	(心膜>-<心臓)	心膜摩擦音

呼吸との関係

右心系：三尖弁の雑音

• 吸気時増強、呼気時減弱

吸うとき強く、吐くとき弱く

吸うと胸腔内圧が陰圧になり、静脈還流量が増加する

左心系：僧帽弁、大動脈弁の雑音

• 吸気時減弱、呼気時増強

吸うとき弱く、吐くとき強く

胸腔内圧が上昇すると、肺から心臓に向かう血流が増加する(ホントニか？)ので、左心系の雑音が増強するのだ？？？？？？？？？？？

手技との関連

• 右心系雑音減弱：Valsalva手技、立位

疾患別

MS

• 概念：拡張期ランブル
• 時相：拡張中期(open snap)に続いて。
• 最強点：心尖部
• 放散：
• 体位：左側臥位
• 音程：低音

MR

• 概念：収縮期逆流性雑音
• 最強点：心尖部
• 放散：左腋窩
• 体位：左側臥位
• 呼吸：呼気
• 音程：高音

AS

• 概念：収縮期駆出性雑音
• 最強点：2LSB
• 放散：右鎖骨下動脈、右頚動脈
• 体位：座位
• 呼吸：呼気

AR

• 概念：拡張期灌水様雑音
• 時相：拡張期
• 特徴：呼気で増強
• 最強点：3LSB
• 放散：
• 体位：座位前屈位
• 音程：高音

MVP

• 概念：収縮期逆流性雑音
• 時相：収縮期中期。クリック音の後から。
• 音程：高音　　←　　圧較差が大きいため

ASD

• 概念：駆出期駆出性雑音
• 最強点：2LSB
• 放散：
• 体位：

病態特異的な心雑音

	三尖弁閉鎖不全症	大動脈弁閉鎖不全症	大動脈弁狭窄症	僧帽弁閉鎖不全症	僧帽弁狭窄症
	TR	AR	AS	MR	MS
心音	I音減弱	I音減弱	奇異性分裂	I音減弱	I音亢進
心雑音	リベロ・カルバロ徴候：吸気時に逆流性雑音が増強	オースチン・フリント雑音：M弁前尖半閉鎖状態による機械的MS		ケリークームス雑音：拡張期雑音。容量負荷による相対的MS
過剰心音					opening snap：拡張期初期M弁開放
その他徴候		二峰性脈：頚動脈や腕頭動脈で収縮期に二峰性の脈を感じる コリガン脈：著しく膨張し虚脱する脈 ミュッセ徴候：収縮期に頭が上下に動く デュロジェ雑音：大腿動脈を軽く押さえると往復雑音が聴取される ヒル徴候：収縮期の膝窩動脈圧が上腕動脈圧よりも60mmHg高い ミュラー徴候：uvulaの収縮期のは駆動 クインケ徴候：口唇や近位爪床で毛細血管の拍動が見える トラウベ徴候：Pistol-shot音が大腿動脈で聴取される

「cardiac」

　　[★]

• adj.

• 心臓の、心の、心臓性、強心の

関

cardio、cardiotonic、heart、mind