Heart murmurs for beginners 🔥 🔥 🔥 Part 1: No background music

foreign [Music] welcome back to the learn medicine show my name is Dr Coleman and in this episode we are covering four heart murmurs which typically come up in exams we're going to start by covering the basic heart sounds and then we'll add in the murmurs so you get to know these let's get into this heart sounds can be graphically represented in medical notes as S1 S2 and S1 again and this represents one movement through the cardiac cycle the gap between S1 and S2 is known as systole and the gap between S2 and S1 is known

as diastole before we start adding in murmurs I want you to be first familiar with the normal heart sound so let's briefly cover these the S1 heart sound usually sounds like the word lub and the S2 dub let's add in the heart sounds briefly so you can familiarize yourself with this now let's turn our attention towards heart murmurs murmurs occur when there is a disruption of normal laminar blood flow the disruption can be caused by physiological or pathophysiological conditions and this leads to turbulent flow which produces audible vibrations and these audible vibrations vary in their

volume based on the turbulent flow produced and these pictorial representation of sound waves are what we use to document murmurs in our heart sounds diagram so let's get down to business now and start by looking at systolic murmurs our first systolic murmur is aortic stenosis aortic stenosis typically produces what's known as an ejection systolic murmur this is a murmur that occurs during systole and is represented by a crescendo de Crescendo sound wave one strategy for recognizing and remembering this murmur is using the schema love washed up we'll now add in the murmur and heart sounds

so you can fully appreciate this murmur is produced by the abnormal narrowing of the aortic valve let's take a closer look now at how this occurs blood flows from the Atria into the ventricles and the first heart sound is produced by closure of the tricuspid and mitral valves systole then occurs where the ventricles contract and this forces blood through the pulmonary and aortic valves narrowing of the aortic valve creates turbulent flow through the aorta it is this turbulent blood flow that produces our Crescendo decrescendo murmur finally the S2 heart sound is produced by closure of

the pulmonary and the aortic valve let's now add in the murmur so that you can appreciate this in real time now that we've heard the murmur let's take a closer look at aortic stenosis aortic stenosis is caused by abnormal narrowing of the aortic valve and the etiology includes age-related calcification congenital bicuspid valve and rheumatic fever the clinical history will typically include angina syncope and dyspnea the murmur of al2 stenosis is characterized as an ejection systolic murmur murmur is louder in Exploration and is heard best in the aortic region and in the apex of the heart

the murmur radiates in the direction of blood flow towards the carotid arteries on clinical examination you may also find a slow Rising pulse and low blood pressure let's turn our attention to mitral regurgitation here we have another systolic murmur but this time it's described as a pan systolic murmur and as you may have already gathered from its name this occurs throughout the entire duration of sisterly this murmur is represented visually with a plateau waveform meaning that the volume of the murmur remains consistent throughout its duration in the Pan's systolic murmur the murmur is so loud

that it drowns out S1 and S2 and instead a burring sound is heard let's pause and take a quick listen to this now foreign [Music] is caused by abnormal closure of the mitral valve let's take a closer look to get a better understanding of this so blood flows from the Atria through the mitral and tricuspid valves into the ventricles and at this point the mitral and tricuspid valves would normally close to produce our S1 heart sound but instead of this the mitral valve prolapses into the left atrium and this causes turbulent blood flow which generates

a murmur that drowns out the S1 and the S2 heart sound let's add in the murmur so that you can appreciate this in real time [Music] mitral regurgitation is caused by abnormal closure of the mitral valve and this can be due to a number of reasons including mitral prolapse ischemic heart disease rheumatic fever and infective endocarditis the clinical history will usually include dyspnea and fatigue mitral regurgitation produces a pan systolic murder that is loudest at the apex of the heart and radiates into the left axilla other signs you may see on examination include a displaced

apex beat and a parasternal heave in severe cases you may see peripheral edema let's now turn our attention towards diastolic murmurs and we're going to cover two the first one is aortic regurgitation this murmur is heard during diastole and is considered an early diastolic murmur it is represented pictorially with a decrescendo sound wave the words can be used to describe how this murmur sounds let's listen to this in real time so you can appreciate this better foreign regurgitation is caused by abnormal closure of the aortic valve let's take a closer look at this using an

animation the first heart sound is produced by closure of the tricuspid and mitral valves systole then occurs during which the ventricles contract forcing blood through the pulmonary and aortic valves incomplete closure of the aortic valve allows blood to regurgitate back into the ventricle this turbulent blood flow causes our diastolic murmur let's now add in the heart sounds and watch this occur in real time [Music] thank you aortic regurgitation is caused by abnormal closure of the aortic valve this may occur due to rheumatic fever but is also seen in connective tissue diseases such as Marfan syndrome

and rheumatological conditions like rheumatoid arthritis and lupus another possible cause is infective endocarditis the clinical history will usually present with dyspnea and the patient may present with symptoms of angina aortic regurgitation produces an early diastolic murmur that is heard loud is that the left sternal Edge and radiates towards the apex of the heart of the signs you might see on clinical examination include a collapsing pulse a wide pulse pressure and a displaced apex beat now let's turn our attention to our final murmur the murmur of mitral stenosis mitral stenosis produces a diastolic mammal that is

described as a mid-diastolic murmur it has an opening snap and a decrescendo sound wave meaning it starts loud and then becomes quieter to help recognize this mid-diastolic murmur the terms are often used let's pause for a moment to listen to this in real time so that you can appreciate this better [Music] mitral stenosis as its name suggests is caused by abnormal narrowing of the mitral valve let's now take a look at an animation to see how this narrowing causes the murmur the S1 heart sound is produced by closure of the tricuspid and mitral valves systole

then occurs where ventricular contraction pushes blood through the pulmonary and aortic valves closure of the pulmonary and aortic valves produces the S2 heart sound but milliseconds after this accumulated blood in the left atrium increases the left atrial pressure to a point where the stiffened mitral valve is forced open and this produces an opening snap almost immediately after S2 blood rushes through the narrowed marginal vowel producing turbulent flow and this is audible vibrations from these that produce our mid-diastolic decrescendo murmur let's take a moment now to add in the murmur so you can appreciate it in

real time [Music] mitral stenosis is an abnormal narrowing of the mitral valve the most common cause of this is rheumatic fever and less common causes include congenital heart disease and systemic diseases such as lupus the clinical history typically presents with dyspnea and palpitations if atrial fibrillation is present mitral stenosis produces amid diastolic murmur with an opening snap that is heard loudest at the Apex and radiates to the axilla other signs that you may see on clinical examination include malar flush and a tapping apex beat and that brings us to the end of the tutorial so

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