machinery murmur

WordNet

1. turn, shape, mold, or otherwise finish by machinery
2. a device for overcoming resistance at one point by applying force at some other point (同)simple_machine
3. any mechanical or electrical device that transmits or modifies energy to perform or assist in the performance of human tasks
4. a group that controls the activities of a political party; "he was endorsed by the Democratic machine" (同)political machine
5. an efficient person; "the boxer was a magnificent fighting machine"
6. an intricate organization that accomplishes its goals efficiently; "the war machine"
7. make by machinery; "The Americans were machining while others still hand-made cars"
8. speak softly or indistinctly; "She murmured softly to the baby in her arms"
9. make complaining remarks or noises under ones breath; "she grumbles when she feels overworked" (同)mutter, grumble, croak, gnarl
10. machines or machine systems collectively
11. a system of means and activities whereby a social institution functions; "the complex machinery of negotiation"; "the machinery of command labored and brought forth an order"
12. making a low continuous indistinct sound; "like murmuring waves"; "susurrant voices" (同)susurrant, whispering

PrepTutorEJDIC

1. 『機械』 / 自動車,飛行機,自転車 / 加えられた力を強めたり方向を変えたりする機械(器具);てこ,滑車,くさび,斜面など / 組織,(特に)派閥 / (自主性も意欲もない)機械のような人,機械的に働く人 / …‘を'機械で作る(仕上げる);(特に)…‘に'ミシンをかける,‘を'ミシンで作る;(印刷機で)…‘を'印刷する / …‘を'きっちり計って作る《+『down』+『名,』+『名』+『down』》
2. (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
3. 《集合的に》《単数扱い》『機械』 / 《集合的に》機械の部品;機械装置 / (社会・政治などの)機構,組織《+『of』+『名』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/05/29 20:43:00」(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.

A mnemonic to remember what characteristics to look for when listening to murmurs is SCRIPT: Site, Configuration (shape), Radiation, Intensity, Pitch and quality, and Timing in the cardiac cycle.

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, rooster 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 aortic valve regurgitation. It is a diastolic murmur which can be heard over the mid-precordium.[1]

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. 大動脈縮窄症の臨床症状および診断 clinical manifestations and diagnosis of coarctation of the aorta
• 3. 動脈管開存症の臨床症状および診断 clinical manifestations and diagnosis of patent ductus arteriosus
• 4. 先天性および小児冠動脈異常 congenital and pediatric coronary artery abnormalities
• 5. 早産児における動脈管開存症の病態生理、臨床症状、および診断 pathophysiology clinical manifestations and diagnosis of patent ductus arteriosus in premature infants

English Journal

• Pseudoaneurysm of the facial artery as a late complication of bilateral sagittal split osteotomy and facial trauma.

• Madani M, Veznedaroglu E, Pazoki A, Danesh J, Matson SL.SourceDepartment of Oral and Maxillofacial Surgery, Capital Health System, Trenton, New Jersey, USA. drmmadani@gmail.com
• Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2010 Nov;110(5):579-84. doi: 10.1016/j.tripleo.2010.03.021. Epub 2010 Jun 26.
• Pseudoaneurysms, or arteriovenous fistulas, of the extracranial arterial system, particularly the facial artery, are rare. Its occurrence after reconstructive facial surgery has been reported rarely in the literature. In this article we describe a rare case of pseudoaneurysm developing over 4 weeks
• PMID 20580283

• Traumatic arteriovenous fistula of the internal mammary vessels.

• Yerebakan C, Westphal B, Kröger JC, Steinhoff G.SourceDepartment of Cardiac Surgery, Medical Faculty, University of Rostock, 18057 Rostock, Germany. can.yerebakan@med.uni-rostock.de
• The Thoracic and cardiovascular surgeon.Thorac Cardiovasc Surg.2009 Oct;57(7):422-4. doi: 10.1055/s-2008-1039268. Epub 2009 Sep 30.
• An uncommon case of traumatic arteriovenous fistula of the left internal mammary artery following penetrating chest trauma is presented. The patient developed a left parasternal machinery murmur six days after thoracotomy to repair a pericardial tamponade after a penetrating left parasternal stab wo
• PMID 19795332

Japanese Journal

• 気管支食道動脈と肺動脈の異常短絡により動脈管開存症と類似所見を呈した犬の1例 (短報) (内科学)

• 山根 剛,粟津 孝子,藤井 洋子 [他],渡邉 俊文,武藤 眞,奥津 正巳,若尾 義人
• The journal of veterinary medical science 63(7), 819-822, s・v, 2001-07
• 心雑音の精査のため来院した1歳齢, 雌, 3.5kgのミニチュアダックスフンドに対して各種検査を実施した. 聴診により左側心基底部に機械様雑音が聴取された. X線検査では軽度の心拡大は認められたが, 大動脈の拡大および肺動脈の拡張などの動脈管開存症に特徴的な所見は認められなかった. 超音波検査では, 肺動脈分岐部より肺動脈幹近位に向かう動脈管からと思われる短絡血流が確認された. 以上の所見より動脈 …
• NAID 110003920698

• Aberrant Branch of the Bronchoesophageal Artery Resembling Patent Ductus Arteriosus in a Dog.

• YAMANE Tsuyoshi,AWAZU Takako,FUJII Yoko,WATANABE Toshifumi,MUTO Makoto,OKUTSU Masami,WAKAO Yoshito
• Journal of Veterinary Medical Science 63(7), 819-822, 2001
• … A cardiac murmur had been observed in the dog during examination at another hospital. … The machinery murmur was auscultated at the left side of the base of the heart. …
• NAID 130000449526

Related Links

• Continuous murmurs - Wikipedia, the free encyclopedia

Since aortic pressure is higher than pulmonary pressure, a continuous murmur occurs. This murmur is often described as a machinery murmur, or Gibson's murmur. This is named for George Alexander Gibson, who characterized it in 1898.

---

★リンクテーブル★

リンク元	「機械様雑音」
関連記事	「machine」「machinery」

「機械様雑音」

　　[★]

英

machinery murmur

同

ギブソン雑音 Gibson murmur、機械様連続性雑音

関

連続性雑音

「machine」

　　[★]

• n.

• 機械、マシーン、器械、装置

関

apparatus、device、instrument、mechanic

　 　 　 　 　 　 　 　

「machinery」

　　[★]

• n.

• 機構、仕組み、マシナリー、機械類

関

mechanism、mechanistic、organization、structure