Systolic murmur at the apex

Not everyone has heard of such a thing as systolic sounds. It is worth saying that this condition may indicate the presence of serious pathologies in the human body. Systolic murmur in the heart indicates that there was a malfunction in the body.

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What is it talking about?

If the patient has sounds inside the body, then this means that the blood flow in the heart vessels is disturbed. There is a widespread belief that systolic murmur is observed in adults.

This means that a pathological process occurs in the human body that indicates some kind of ailment. In this case, it is urgent to undergo a cardiological examination.

Systolic murmur implies its presence between the second heart tone and the first. Sound is recorded on the heart valves or blood flow.

There is a certain gradation in the separation of data from pathological processes:

  1. Functional systolic murmur. It refers to an innocent manifestation. There is no danger to the human body.
  2. Organic systolic murmur. Such a noise character indicates the presence of a pathological process in the body.

An innocent type of noise can indicate that there are other processes in the human body that are not related to heart disease. They are of a soft nature, not long, have a weakly expressed intensity. If a person reduces physical activity, then the noise will disappear. Data may vary depending on the posture of the patient.

Sound effects of a systolic nature occur due to septal disorders and valvular. Namely, in the human heart there is a dysfunction of the septa between the ventricles and atria. They differ in the nature of the sound. They are solid, tough and stable. There is a gross systolic murmur, its long duration is recorded.

These sound effects extend beyond the borders of the heart and are reflected in the axillary and interscapular zones. If a person subjected his body to exercises, then sound abnormalities persist after they are over. During physical activity, noise is amplified. Organic sound effects that are present in the heart are independent of body position. They are equally well heard in any position of the patient.

Sound cardiac effects have different acoustic meanings:

  1. Systolic murmurs of early manifestation.
  2. Pancystolic murmurs. They also have such a name as holistolic.
  3. Mid-late noises.
  4. Systolic murmur at all points.

What are the causes of systolic murmur? There are several basic ones. These include:

  1. Aortic stenosis. It can be either congenital or acquired in nature. This disease occurs due to narrowing of the aorta. With this pathology, the valve walls are fused. This situation complicates the flow of blood inside the heart. Aortic stenosis can be attributed to the most common heart disease in people in adulthood. The consequence of this pathology may be aortic insufficiency, as well as mitral defect. The aortic system is designed in such a way that calcification is produced. In this regard, the pathological process intensifies. It is also worth mentioning that with aortic stenosis, the load on the left ventricle increases. In parallel with this, the brain and heart experience insufficient blood supply.
  2. Aortic insufficiency. This pathology also contributes to the occurrence of systolic murmur. With this pathological process, the aortic valve does not close completely. Infectious endocarditis causes aortic insufficiency. The impetus for the development of this disease is rheumatism. Also, lupus erythematosus, syphilis and atherosclerosis can provoke aortic insufficiency. But injuries and defects of a congenital nature rarely lead to this ailment. A systolic murmur on the aorta suggests that the valve has aortic insufficiency. The reason for this may be the expansion of the ring or aorta.
  3. Washing jumping off an acute course is also the reason that systolic murmurs appear in the heart. This pathology is associated with the rapid movement of fluids and gases in the hollow regions of the heart when they are reduced. They move in the opposite direction. As a rule, this diagnosis is made in case of dysfunction of the dividing walls.
  4. Stenosis. This pathological process is also the cause of systolic murmur. In this case, the narrowing of the right ventricle, namely its tract, is diagnosed. This pathological process refers to 10% of cases of noise. In this situation, they are accompanied by trembling of a systolic nature. The vessels of the neck are particularly exposed to irradiation.
  5. Stenosis of the tricuspid valve. With this pathology, the tricuspid valve narrows. As a rule, rheumatic fever leads to this disease. Patients have indicators such as cold skin, fatigue, discomfort in the neck and abdomen.

Why can there be a heart murmur in a child? There are many reasons. Below will be listed the most common. So, there may be heart murmurs in the child due to the following pathologies:

  1. Violation of the atrial septum. In this case, we are talking about the absence of tissue in it. This situation leads to the discharge of blood. The volume of blood discharged depends on the size of the defect and the compliance of the ventricles.
  2. An abnormal state of the venous return of the lungs of a child’s body. There are cases of abnormal formation of pulmonary veins. The essence of this is that the pulmonary veins do not communicate with the atrium on the right. They can grow together with the veins of a large circle.
  3. Coarctation aortic. In this case, we are talking about narrowing of the thoracic aorta. A child is diagnosed with heart disease. Segmental aortic lumen is smaller than expected. This pathology is treated through surgery. In case of failure to provide medical care as they mature, aortic narrowing will increase.
  4. Pathology of the interventricular septum. Such a defect also leads to the fact that there are noises in the heart of a systolic nature. This pathology can be isolated. That is, to develop on its own or be combined with other cardiac dysfunctions.

It is worth saying a few words about newborn babies. Immediately after birth, a complete examination of the body. Including listening to the heart rate. This is done in order to exclude or detect any pathological processes in the body.

With such an examination, the possibility of detecting any noise is present. But they do not always have to be cause for concern. This is due to the fact that noises are quite common in newborn babies. The fact is that the child’s body is rebuilt under the external environment. The heart system is reconfigurable, so various noises are possible.

The presence of congenital noises in the baby’s body is determined during the first three years of life. Noises in newborn babies may indicate that during development before birth, the heart was not fully formed for various reasons. In this regard, after birth, the baby is recorded noise. They talk about congenital heart defects. In the case when pathologies have a high risk for the health of the child, doctors decide on the surgical method of treating a particular pathology.

It is worth knowing that the characteristic of noise can vary depending on their location. For example, there is systolic murmur at the apex of the aorta.

  1. Mitral valve pathology and related acute failure. In this position, the noise is short-lived. Its manifestation occurs early. If this type of noise is fixed, then the following pathologies are revealed in the patient: hypokinesis, chord rupture, bacterial endocarditis, and so on.
  2. Systolic murmur on the left edge of the sternum.
  3. Chronic mitral valve insufficiency. This type of noise is characterized by the fact that they occupy the entire duration of ventricular contraction. The magnitude of the valve defect is proportional to the volume of blood returned and the nature of the noise. This noise is better heard if the person is in a horizontal position. With the progression of heart disease, the patient experiences vibration in the chest. There is also systolic murmur at the base of the heart. Vibration is felt during systole.
  4. Mitral insufficiency of a relative nature. This pathological process lends itself to therapy with proper treatment and adherence to recommendations.
  5. Systolic murmur with anemia.
  6. Pathological disorders of the papillary muscles. This pathology relates to myocardial infarction, as well as to ischemic disorders in the heart. Systolic murmur of this type is variable. It is diagnosed at the end of systole or in the middle. There is a short systolic murmur.

When a woman is pregnant, the occurrence of processes such as systolic murmurs in her heart is not ruled out. The most common cause of their occurrence is the load on the girl’s body. As a rule, heart murmurs appear in the third trimester.

In the case when a woman fixes them, the patient is placed under more careful control. In a medical institution where she is registered, her blood pressure is constantly measured, her kidney function is checked and other measures are taken to monitor her condition. If a woman will be constantly monitored and implement all the recommendations that doctors give her, then bearing a child will be in a good mood without any consequences.

First of all, the doctors are faced with the task of determining whether there is a heart murmur or not. The patient undergoes an examination such as auscultation. During her, a person must first be in a horizontal position, and then in a vertical position. Also, listening is done after exercise in the position on the left side on the inhale and exhale.

Types of heart murmur in an adult

The pathogenesis of the phenomenon is simple. Systolic murmur at the apex of the heart occurs as a result of a violation of the linear flow of blood during contraction of the ventricles, resulting in turbulences that create additional sounds. This is observed with narrowing, abnormal formations, regurgitation (pathological return), accelerated blood flow (due to changes in composition, as in anemia).

If normal tones sound like clear beats, then pathological noises resemble buzzing, hissing, rustling. They are accompanied by additional phenomena – “cat purr” (diastolic trembling), conducting to the axillary region (region of the scapula), heart palpitations.

Depending on the etiology of this auscultatory phenomenon, functional (they are also called innocent) and organic noises are distinguished. The former include everyone with a transitory character. And under certain conditions, a normal state is restored. The second type occurs during structural changes in heart tissue. In this case, the process is considered non-negotiable, and treatment is difficult.

Functional (innocent) noises appear in such cases:

  • physical overstrain;
  • nervous agitation and neurosis;
  • fever, infectious diseases;
  • hyperthyroidism;
  • anemic syndrome;
  • asthenic constitution;
  • pregnancy;
  • relative insufficiency of valves.

Organic noise is characteristic of such pathologies:

  • coarctation (narrowing) of the aorta or pulmonary arteries;
  • expansion of the aorta or other vessels;
  • aortic valve insufficiency;
  • additional abnormal chords;
  • mitral or tricuspid insufficiency;
  • valve stenosis;
  • combined vices.

The detection of systolic murmurs in the heart of a child does not yet speak of dangerous diseases. Often a similar condition is found in infants, but the reason is the imperfect development of the cardiovascular system, the disproportion of certain structures. This usually goes away with age.

Another source is individual congenital structural features of the heart (additional chords (cords connecting the papillary muscles and valves)). This is considered a normal option and does not require any treatment.

Often this phenomenon develops due to physical or nervous stress, fever or infectious diseases. When these conditions pass, systolic murmurs disappear.

There are many dangerous diseases in which this diagnostic sign is also detected. These include:

  • ventricular septal defect – in this case, blood is discharged from one ventricle to another;
  • anomalies of pulmonary veins and aorta – include the expansion or narrowing (coarctation) of blood vessels;
  • congenital malformations of the valves (insufficiency or stenosis) – in this case, the blood returns to the heart cavities, or it hardly passes through the narrowed lumen;
  • combined pathologies (tetrad, Fallot pentad) – combine several developmental anomalies at once.

If systolic murmur is detected in you or your child, this means that additional examinations are necessary in order to identify the specific cause of this phenomenon.

Moreover, the following diagnostic procedures are used:

  • electrocardiography (ECG);
  • Holter daily ECG monitoring;
  • chest x-ray;
  • echocardiography (ultrasound of the heart);
  • functional load tests (bicycle ergometry, step test);
  • magnetic resonance or computed tomography.

They make appropriate laboratory tests, which include a general and biochemical analysis of blood and urine, rheumatic tests, a coagulogram and other specific studies.

In addition, the patient will need a consultation of a rheumatologist, allergist, endocrinologist. If no organic changes are found, then the person is simply put in control. This means that he needs to periodically come to the hospital for a routine examination. Prescribe and restorative agents (exercise therapy or physiotherapy). If serious pathologies are detected, the patient is prescribed treatment.

conclusions

Systolic murmurs appear due to a violation of normal blood flow in the cavities of the heart, changes in blood composition or the presence of barriers and abnormal structures. Such sounds are heard at the time of ventricular myocardial contraction.

Functional (innocent) noises occur in pathological conditions not associated with a violation of the internal architectonics of the heart, and usually disappear with time. Organic ones develop during structural changes and signal serious diseases. To establish the exact cause, additional examinations are prescribed.

The following sources of information were used to prepare the material.

Medicine noises are divided into organic, which indicate the presence of cardiac pathology, and functional, which are “innocent” noises. Organic heart murmurs are sounds that may have arisen due to congenital or acquired malformations, as well as other heart diseases.

In most cases, organic noise occurs due to a valve or septal defect (interventricular or atrial septal defect). Organic noises have a hard, coarse, persistent timbre; loud, sharp intensity; they are long, they are characterized by holding beyond the borders of the heart, axillary or in the interscapular region. After exercise, organic noise amplifies; their equal audibility in any position of the body is noted, they have a connection with heart sounds.

Functional murmurs in the heart are called “innocent”, since there is no connection with heart diseases, they can be heard in the presence of other diseases that are not related to heart pathologies. Functional noises have a soft, musical, inconstant timbre, weak intensity, they are short, are not carried out of the heart.

Systolic murmur in the heart

– 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.

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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.

To understand what are the causes of noise in the heart, you must first turn to their classification. So, systolic murmur in the heart happens:

The latter is associated with morphological changes in the heart muscle and valves. It is divided into noises of expulsion and regurgitation, narrowing of the mouth of the pulmonary aorta or pulmonary arrhythmia, and deviations in the functioning of the valves, respectively.

In the first case, the noise is quite strong and sharp, is heard in the second intercostal space on the right and spreads towards the right clavicle. In the place of his listening and on the carotid artery, systolic oscillation is felt. The time of occurrence is determined by the first tone and amplifies to the median systole. With a sharp narrowing, the noise peak falls on the second part of the systole due to the delayed expulsion of blood.

Systolic murmur with an increase in the mouth of the aorta is less sharp, there is no trembling. The maximum force is at the beginning of systole, the second tone is amplified and sonorous. In patients of retirement age during atherosclerosis, in addition to systolic murmur above the aorta, a similar sound is also heard above the apex of the heart, in other words it is called aortic mitral systolic murmur.

During narrowing of the mouth of the pulmonary artery, it is heard in the second left intercostal space and is distributed towards the clavicle on the left. The sound is strong and rough, and trembling is also felt. The second tone is bifurcated into pulmonary and aortic components.

Non-enlargement of the septum between the ventricles is characterized by loud and gross systolic murmur, heard in the fourth and third intercostal space. The deviation in the functioning of the mitral valve is accompanied by a noise above the apex of the heart, which spreads towards the armpits, originates immediately after the first tone and becomes weaker towards the end of the systole. At the bottom of the sternum, it is determined with a tricuspid valve insufficiency, similar to mitral murmurs, quiet and hardly distinguishable.

Coarctation of the aorta is characterized by a noise near the base of the heart muscle, which is heard louder in the back and above the shoulder blade on the left, spreading along the length of the spine. It starts after the first tone with a slight lag and ends after the second tone. The open botallal duct is accompanied by systolic murmur resulting from the flow of blood into the pulmonary artery from the aorta. This happens during both cycles, audibility is clearer under the left clavicle or over the pulmonary artery.

Systolic murmurs can occur in children in the first year of life, which, as a rule, is a sign of restructuring of the circulatory system.

Quite often, these symptoms are diagnosed in children. The causes of noise in adolescence include the rapid growth of the entire body of the child and the restructuring of the endocrine system. The heart muscle does not keep up with the growth, in connection with which certain sounds appear that relate to temporary phenomena and cease as the work of the child’s body stabilizes.

Common phenomena include the occurrence of noise in girls during puberty and the onset of menstruation. Frequent and heavy bleeding can be accompanied by anemia and heart murmur. In such cases, parents need to take measures to normalize the menstrual cycle after consulting a pediatric gynecologist.

An excess of thyroid hormones can also cause heart murmurs.

In the case of their diagnosis in adolescents, doctors are primarily referred to an examination of the thyroid gland in order to identify the true causes of the disorders.

Insufficient or overweight in adolescents affects the functioning of the heart muscle, so proper nutrition during the period of active growth of the body is so important.

However, vegetovascular dystonia is the most common cause of noise. Additional symptoms include headaches, permanent weakness, and fainting.

If such deviations occur in adults over the age of 30, which is a rather rare phenomenon, then I associate them with the organic narrowing of the carotid artery.

Hemodynamic changes in the cardiovascular system cause the layered blood flow to turn into a vortex, which causes vibration of the surrounding tissue, conducted to the surface of the chest and perceived as sound phenomena in the form of systolic noise.

Crucial for the occurrence of vortex movements and the appearance of systolic noise is the presence of an obstruction or narrowing in the blood flow, and the strength of systolic noise is not always proportional to the degree of narrowing. A decrease in blood viscosity, for example with anemia, creates conditions that facilitate the occurrence of systolic murmur.

Systolic murmurs are divided into inorganic, or functional, and organic, due to morphological changes in the heart and valvular apparatus.

Functional systolic murmurs include: 1) systolic murmur of relative mitral insufficiency, heard over the apex of the heart; 2) systolic murmur over the aorta during its expansion; 3) systolic murmur with aortic valve insufficiency; 4) systolic murmur over the pulmonary artery during its expansion;

6) systolic murmur with fever, sometimes found above the aorta and pulmonary artery; 7) systolic murmur with severe anemia and thyrotoxicosis, auditioned over the entire region of the heart.

Systolic murmur arising from the expansion of the aorta or pulmonary artery is associated with a relative narrowing of the mouths of these vessels and is most audible at the very beginning of systole, which distinguishes it from systolic murmur with organic stenosis. Systolic murmur in case of aortic valve insufficiency depends on the increase in stroke volume of the left ventricle and the rate of expulsion of blood through the relatively narrowed aortic mouth.

In addition, the so-called physiological systolic murmur is often referred to as functional systolic murmur, which is often heard in young healthy people on the base, and sometimes on the top of the heart. Physiological systolic murmur over the pulmonary artery can be heard in healthy people aged 17-18 years in 30% of cases, mainly in people with asthenic physique.

What is it talking about?

  1. The most serious reason that is primarily thought of is congenital heart disease. This pathology is found in approximately one in one hundred children.
  2. Stenosis (narrowing of blood vessels or valves of the heart)
  3. Inadequate closure of heart valves.
  4. Holes in the heart walls.
  5. Lack of septum between the aorta and pulmonary artery.
  6. Small abnormalities of the heart (additional chords or trabeculae in the cavities of the heart).

Noise classifications

Functional noises are classified as follows:

  • with mitral insufficiency are heard above the apex of the heart;
  • above the aorta with its increase;
  • arising from aortic valve insufficiency;
  • over the pulmonary artery during its extensions;
  • during nervous excitement or physical exertion, accompanied by tachycardia and sonorous tones;
  • appearing with fever;
  • arising from thyrotoxicosis or severe anemia.

By its nature, noise is distinguishable by a heartbeat, and treatment depends on its volume, frequency and strength. There are six volume levels:

  1. Barely distinguishable.
  2. At times disappearing.
  3. Constant noise, more sonorous and without wall jitter.
  4. Loud, accompanied by oscillation of the walls (can be distinguished by placing a palm).
  5. Loud that is heard in any area of ​​the chest.
  6. The loudest, you can easily hear, for example, from the shoulder.

The volume is affected by body position and breathing. So, for example, when you inhale, the noise intensifies, as the reverse of blood to the heart muscle increases; when standing, the sound will be much quieter.

What can be systolic murmur at the top of the heart?

The beginning of the formation of the heart is considered the second week of pregnancy. From the third month, it can work, and tissue nutrition is carried out by pumping blood from the placenta. The structure of the heart of the fetus is characterized by the presence of three features:

  • oval window
  • ductus arteriosus
  • venous trunk.

Venous blood from the right atrium passes into the right ventricle through the superior vena cava, and its part (from the lower) through the opening in the septum flows into the left atrium, then into the ventricle and further through the arteries.

After childbirth, the lungs straighten, and a blood stream enters them, and all the auxiliary vessels and openings that were needed earlier are closed. This is facilitated by increased pressure in the left half of the heart, closing the window between the atria, as well as the work of the nervous and muscular systems.

The properties of the circulatory system, which are characteristic only for the newborn, include:

  • the heart has a large specific gravity in relation to the body;
  • the thickness of the myocardium in the left and right sections is approximately equal;
  • located higher than in adults;
  • heart rate is high and can reach 200 beats with crying, fever, anxiety or stress;
  • blood pressure is low;
  • by 6 years, the mass increases by about 10 times;
  • the heart muscle has an intense blood supply.

These features help the heart do a lot more work than adults. Moreover, the development of various structures does not always occur synchronously.

For early childhood, the occurrence of noise in the heart due to uneven blood movement is one of the normal options.

They are called physiological, or “innocent,” which means that at the end of the formation of the structure of the heart chambers (by the age of 10), they disappear on their own. Their presence is not accompanied by consequences for the health of the child.

Systolic murmur of stenosis of the aortic orifice is coarse and strong, is heard in the second right intercostal space at the sternum and spreads up to the right clavicle and neck arteries; systolic trembling is palpated at the place of listening and on the carotid arteries; noise occurs after the first tone, the noise intensity increases towards the middle of the systole.

In the case of severe stenosis, the maximum noise occurs in the second half of systole due to delayed expulsion of blood. Systolic murmur during the expansion of the sclerosed aorta is not so rough, there is no systolic tremor, the maximum noise is determined at the beginning of systole, and the second tone is sonorous or amplified.

With a narrowing of the mouth of the pulmonary artery, systolic murmur is heard in the second intercostal space on the left; the noise is rough, strong, spreads to the left clavicle, accompanied by systolic trembling at the site of auscultation; the second tone is bifurcated with the location of the pulmonary component earlier than the aortic. With sclerosis and expansion of the pulmonary artery, a maximum of systolic noise is heard at the beginning of systole, the second tone is usually significantly enhanced.

With non-closure of the interventricular septum due to the passage of blood through a small defect from the left to the right ventricle, a rough and loud systolic murmur appears in the third and fourth intercostal spaces on the left near the sternum, sometimes with a distinct systolic tremor.

Systolic murmur with mitral valve insufficiency is best heard above the apex, spreading to the axillary region; a blowing noise starting immediately after the first tone and weakening towards the end of the systole.

Systolic murmur with tricuspid valve insufficiency is heard in the lower part of the sternum; often it is very quiet and difficult to distinguish from coexisting systolic murmur of mitral origin.

Systolic murmur during coarctation of the aorta is heard on the basis of the heart, region of the aorta and pulmonary artery, but it is often louder on the back in the region of the left suprascapular fossa, spreading along the spine; the noise begins some time after the first tone and may end after the second tone.

If constant systolic murmur is detected, the patient should be referred to a doctor for a thorough examination of the cardiovascular system.

– 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.

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, 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. 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).

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 child’s aorta 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 murmur in the heart of 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.

What is it talking about?

Mesosystolic murmurs begin after S1, end before S2 and usually have a diamond-shaped configuration. AS is the most common cause of mesosystolic murmur in adults. The exact determination of the severity of valve damage depends on the amount of cardiac output, CA elasticity, and associated symptoms. There are other possible causes of mesosystolic murmur, for example, with GOKMP, pulmonary stenosis and an increase in pulmonary blood flow in patients with bleeding from left to right with ASD.

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Systolic murmur in the heart: diagnosis and treatment

What is it talking about?

The article provides basic data on heart murmurs in a child: the causes of what it is and the main types of noise. Symptoms of pathological noise, their diagnosis, and how to treat a child.

The author of the article: Yachnaya Alina, oncologist surgeon, higher medical education with a degree in General Medicine.

Heart murmur is a sound image of a violation of the movement of blood through the chambers of the muscle, which can be heard between heart tones.

On examination, the pediatrician evaluates the child’s heart by ear, using a stethophonendoscope. There are two main heart tones:

  1. The first, or systolic, is the sound of slamming valve flaps between the atria and ventricles during the contraction of the heart muscle (systole).
  2. The second, or diastolic, is the closure of valve flaps of the pulmonary artery and aorta at the beginning of cardiac relaxation (diastole).

A child is traditionally considered a person from birth to adolescence (about 12-13 years), although under the supervision of a pediatrician they are up to 18 years old. A feature of heart murmur in the childhood period is the presence of a “physiological” sound of muscle work. In the adult population, any sound changes in the work of the heart are evidence of a pathological process. There are no other differences in “noise” between age categories.

In the first year of life due to the restructuring of the circulatory system to work outside the mother’s body

May intensify or first appear during periods of active growth of the child (preschool – early school and adolescence), against the background of uneven growth of the heart muscle and its parts

No changes in the condition of the child, impaired development

No pathology with additional studies (ECG, sonography, x-ray)

No treatment required

May be congenital or acquired due to other diseases

There are changes in additional studies

Not always accompanied by clinical manifestations.

In some cases, requires treatment, including surgical

Frequent inspection of specialists is required.

May be life threatening, leading to disability.

Given that physiological noise does not require treatment, does not affect the quality and life expectancy of the child, then we will only talk about pathological heart murmur (it can be more or less dangerous – depending on its cause).

Local pediatricians, pediatric cardiologists and cardiac surgeons are involved in monitoring and, if necessary, treating children with heart murmurs.

There are clinical cases where noise is the only sign of heart disease. This can be with a slight defect or good compensatory conditions. So, combined vices are known, one of which neutralizes the other.

Most children with congenital structural abnormalities show pallor or

Newborns refuse to breast, as they quickly lose strength when sucking, capricious and restless.

At an older age, children grow slowly, gain weight slightly, and lag behind their peers in physical development. Heart murmurs are often combined with tachycardia or more complex rhythm disturbances. With an increase in decompensation, there are swelling on the legs, coughing, asthma attacks, and the liver increases.

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, it 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.

Various technologies are used to diagnose the condition of the heart. Their application is necessary, since the conclusions drawn on the basis of the obtained physical data need confirmation. To achieve this goal, specialists use FKG, ECG, X-ray of the heart in three projections, echocardiography, including transesophageal.

As an exception, strict indications use invasive diagnostic methods (sounding, contrast methods, etc.).

Physical activity (isometric, isotonic and wrist dynamometry);

Breathing (increased noise from the left and right heart as you exhale)

Atrial fibrillation and extrasystole;

Positional changes (raising legs in a standing position, changing the patient’s body position and squats);

– (fixation of breath with closed mouth and nose), etc.

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.

– physical activity (isometric, isotonic and wrist dynamometry);

– breathing (increased noise from the left and right heart on the exhale)

– Atrial fibrillation and extrasystole;

– positional changes (raising legs in a standing position, changing the position of the patient’s body and squats);

– Valsalva test (fixing breath with closed mouth and nose), etc.

If noise is detected, you should first contact a cardiologist who will diagnose and identify the root cause of the deviation. Do not neglect the recommendations of a doctor. Health and further life directly depend on the timeliness of the actions taken. Of course, each of the subspecies of such manifestations has its own characteristics, however, heart murmurs cannot be attributed to a natural phenomenon.

To detect noise, a specific analysis scheme is used:

  1. First determine the phase of the heart in which it is heard (systole or diastole).
  2. Next, its strength is determined (one of the degrees of volume).
  3. The next step is to determine the relation to the heart sounds, that is, it can deform the heart sounds, merge with them or be heard separately from the heart sounds.
  4. Then its shape is determined: decreasing, growing, rhomboid, ribbon-like.
  5. Consistently listening to the entire area of ​​the heart, the doctor determines the place where the noise is clearly audible. Checking the irradiation of the deviation is to determine the venue.
  6. The penultimate stage of diagnosis is to determine the effect of the phases of respiration.
  7. After that, the doctor determines the dynamics of noise over time: it can be a day, a week, a month, etc.

For differential diagnosis, the time of occurrence of systolic murmurs and their duration using laboratory tests is determined.

Typically, the following tests are prescribed:

  • radiography, which allows you to determine the thickening of the walls of the heart, hypertrophy or enlarged chambers of the heart;
  • ECG – determines the level of overload of various sections;
  • Echocardiography – used to detect organic changes;
  • catheterization.

With systolic murmur, symptoms such as fatigue, arrhythmia, shortness of breath, dizziness, and palpitations are also often observed. In human behavior, this manifests itself through a decrease in appetite, depressive states, and insomnia.

Of course, treatment is directly related to the causes of systolic murmur. If they are one of the signs of vegetative-vascular dystonia, for example, a comprehensive treatment of all the symptoms is carried out simultaneously.

The need for additional examinations arises only if such sounds do not pass for a long time and intensify as the child grows and develops. A heart murmur in a child that occurs in age, eliminates the presence of congenital malformations and, as a rule, completely disappears with age without outside interference.

So, depending on the nature of the phenomenon, treatment can be both medical and surgical. In the case of the functional nature of the noise, regular medical supervision is sufficient.

In order to diagnose noise effects in the human body, special technological tools are used, namely: FCG, ECG, radiography, echocardiography. Radiography of the heart is done in three projections.

There are patients to whom the above methods may be contraindicated, since they have other pathological processes in the body. In this case, invasive methods of examination are prescribed to the person. These include sensing and contrast methods.

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.

Why does the noise appear in children?

The main reason for the appearance of noise in a child under six months of age is their physiological origin, associated with a change in the functional activity of the cardiovascular system after birth and the inclusion of a small circle of blood circulation, in particular, an oval window through which a part of the blood was discharged from the right to the left atrium during the prenatal period.

  • Non-enlargement of the oval window, arterial or venous duct, which should normally close at the age of 1 year.
  • A ventricular septal defect is a malformation in which there remains an opening connecting the right and left ventricles.
  • Any congenital malformations accompanied by narrowing (stenosis) or valve insufficiency.

The development of noise in a child per year can often be unrelated to organic changes. So an increase in body temperature during infectious intoxication of the body or after exercise can be accompanied by the appearance of noise.

  1. Violation of the atrial septum. In this case, we are talking about the absence of tissue in it. This situation leads to the discharge of blood. The volume of blood discharged depends on the size of the defect and the compliance of the ventricles.
  2. An abnormal state of the venous return of the lungs of a child’s body. There are cases of abnormal formation of pulmonary veins. The essence of this is that the pulmonary veins do not communicate with the atrium on the right. They can grow together with the veins of a large circle.
  3. Coarctation aortic. In this case, we are talking about narrowing of the thoracic aorta. A child is diagnosed with heart disease. Segmental aortic lumen is smaller than expected. This pathology is treated through surgery. In case of failure to provide medical care as they mature, aortic narrowing will increase.
  4. Pathology of the interventricular septum. Such a defect also leads to the fact that there are noises in the heart of a systolic nature. This pathology can be isolated. That is, to develop on its own or be combined with other cardiac dysfunctions.
  5. Congenital heart defects in children. An arterial defect of the open type can also cause the presence of systolic murmurs in a child. A vessel is present in the structure of the cardiac system. It is a connecting element between the pulmonary artery and the descending aorta. The function of this organ is to have the baby take the first breath after birth. Then after a small amount of time this vessel closes. There are cases of failure of this process. Then the process of shunting blood from a large circle of blood circulation to a small one continues to be carried out. This is the defect in the body. In the case when a breakthrough passes a small blood flow through itself, this does not particularly affect the health of the child. But if a large blood flow occurs, then the baby may begin complications. Namely, an overload in the work of the heart may occur. In this situation, certain symptoms appear in the body, such as shortness of breath. It also matters which heart strains are present in the baby’s body. If their flow is large, then it is possible that the condition of the newborn will be extremely difficult. In this situation, in addition to systolic murmurs, the heart itself increases in size. The child is assigned an urgent surgery.

Systolic heart murmur in a child or adult: causes and actions

An important point in this matter is the exclusion of other noises that may be present in the human body. For example, with a disease such as pericarditis, noise can also occur.

Also, for accurate diagnosis of the patient’s condition, namely, to measure the intensity of noise, various tests are used. The following methods are used:

  1. Exercise patient load. Isometric, isotonic, carpal dynamometry.
  2. The patient’s breathing is heard. It is determined whether the noise exacerbates as the patient exhales.
  3. Extrasystole.
  4. Change in the poses of the person being examined. Namely, raising legs when a person is standing, crouching and so on.
  5. Breath holding. This examination is called a Valsalva test.

It is worth saying that it is necessary to make timely diagnostics to detect noise in the human heart. An important point is to establish the cause of their occurrence. It should be remembered that systolic murmur may mean that a serious pathological process occurs in the human body. In this case, identifying the type of noise at an early stage will help to take all the necessary measures to treat the patient. However, they, too, may not have any serious deviations and will go through a certain time.

It is necessary that the doctor carefully diagnose the noise and determine the cause of its appearance in the body. It is also worth remembering that they accompany a person at different age periods. Do not be frivolous with these manifestations of the body. It is necessary to bring the diagnostic measures to the end.

It is recommended to check the work of the heart even if a person has no complaints about the work of this body. Systolic murmurs can be detected by chance. Diagnosing the body allows you to identify any pathological changes at an early stage and take the necessary treatment measures.

Types of noise or what the noise in the baby’s heart means

It is customary to distinguish between two types of noise in newborn children:

  1. Functional (or “innocent”). Such heart murmurs absolutely do not affect the health of the infant and do not require additional treatment. Usually arise for two reasons:
  • if the doctor on ultrasound diagnostics detects an “open oval window” in the heart. Usually it has a tendency to decrease and eventually closes. To confirm this, it is recommended to carry out an ultrasound of the baby – it is better to do it at the age of 6 to 12 months. When you close the oval window, the noise also disappears.
  • extra chord abnormally located in the heart. This is a very common phenomenon, often hereditary, which does not threaten the life and health of the child.
  1. Pathological noises. Usually they are accompanied by specific signs of cardiovascular problems (cyanosis of the skin and shortness of breath, weak palpation of the pulse in the lower extremities). The reason for this can be diseases such as a defect in the interventricular or atrial septum, various heart defects, unclosed duct ducts and others.

Based on the results of the ECG, the doctor may order to continue the examination using ultrasound. Ultrasound allows you to “see” all parts of the heart, to evaluate the speed of blood flow and pressure on the walls of blood vessels. This type of diagnosis is absolutely safe for the baby.

In especially severe cases, it may be necessary to perform computed or magnetic resonance imaging of the heart with or without contrast medium. Typically, such a study is carried out in a hospital.

From medical forums: Sometimes, in the treatment of heart murmur, hormonal drugs may be indicated to the child. If heart failure is detected, the baby is prescribed diuretics.

Surgical intervention makes sense if conservative treatment does not bring positive results, or if the condition worsens. The complexity of the operation depends on the severity of the pathology and the age of the child.

Children under one year of age are prescribed surgery in exceptional cases, when their life depends on it. Postoperative recovery and rehabilitation usually takes about two years.

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Cardiac murmurs during pregnancy

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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.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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