Sep 25, A bruit is generally a sound made by a non-cardiac vessel, while a murmur is made by abnormal flow through a cardiac valve either accelerated by a narrowing, or backflowing through an incompetent valve.
Has 5 years experience. A bruit is not usually heard over the part of the chest where you hear heart sounds. It can be heard over the carotids, femoral arteries, A-V fistula sites, etc. A bruit sounds like a washing machine to me. Ok, a really small washing machine A murmur is abnormal noises made by heart valves. So a bruit over the heart would be a Either something's really blocked the vessel, or there's a pseudoaneurysm going on. Both of which could happen to the aorta near the heart, but golly.
I think if I heard that I'd have several other people in there listening just to make sure. Sep 26, A bruit is generally a sound made by a non-cardiac vessel, while a murmur is made by abnormal flow through a cardiac valve. A bit too basic, LOL. I know the physiological difference between the two--but I'm wondering how they sound different. Other heart murmurs may indicate an abnormality in the heart. These abnormal murmurs can be caused by:. Children often have murmurs as a normal part of development.
They may include:. A provider can listen to your heart sounds by placing a stethoscope on your chest. You will be asked questions about your medical history and symptoms, such as:. The provider may ask you to squat, stand, or hold your breath while bearing down or gripping something with your hands to listen to your heart.
Chest sounds - murmurs; Heart sounds - abnormal; Murmur - innocent; Innocent murmur; Systolic heart murmur; Diastolic heart murmur. History and physical examination: an evidence-based approach.
Philadelphia, PA: Elsevier; chap Goldman L. Approach to the patient with possible cardiovascular disease. Goldman-Cecil Medicine.
PMID: pubmed. The classic murmur of aortic stenosis is a high-pitched, crescendo-decrescendo diamond shaped , midsystolic murmur located at the aortic listening post and radiating toward the neck.
Enlarge The radiation of the AS murmur is often mistaken for a carotid bruit. The AS murmur is also known to radiate to the cardiac apex on occasion, making it difficult to distinguish if mitral regurgitation is also present. The intensity of the murmur of AS is not a good indicator as to the severity of disease. As AS worsens, the LV begins to fail, and the ejection fraction declines to the point where sufficient force to create turbulent flow is no longer produced, resulting in a decrease in the intensity of the murmur.
While the intensity of the murmur may not be an accurate determinant of aortic stenosis severity, the shape of the murmur can be very helpful. As aortic stenosis worsens, it takes longer for blood to eject through the valve, so the peak of the crescendo-decrescendo murmur moves to later in systole.
Therefore, mild aortic stenosis would have a murmur that peaks early in systole, whereas the murmur of severe aortic stenosis would peak later. Remember from the Heart Sounds Topic Review that the delay in aortic valve closure can cause a paradoxically split S2 heart sound and, as the aortic valve becomes more heavily calcified, the intensity of the S2 heart sound declines.
Also, in patients with bicuspid aortic valves, an ejection click may be heard just before the murmur begins. The murmur of pulmonic stenosis is very similar to that of aortic stenosis. It is a midsystolic, high-pitched, crescendo-decrescendo murmur heard best at the pulmonic listening post and radiating slightly toward the neck; however, the murmur of pulmonic stenosis does not radiate as widely as that of aortic stenosis. The murmur of pulmonic stenosis peaks early if the disease is mild and peaks later as the disease progresses.
Also, this murmur demonstrates increased intensity during inspiration due to the increased venous return to the right heart, resulting in greater flow across the pulmonic valve. Enlarge Compared with the murmur of aortic stenosis that extends up to the A2 heart sound, the murmur of pulmonic stenosis extends through the A2 sound up to the P2 heart sound.
Severe PS results in decreased mobility of the pulmonic valve leaflets, and thus a softer P2 sound. Also, as the PS worsens, the closure of the pulmonic valve is delayed, because more time is required to eject blood through the stenotic valve; this results in a widely split S2 heart sound that still exhibits inspiratory delay. Note that the murmur of an ASD, discussed below, is also midsystolic; however, it has a fixed split S2. The murmur produced by an atrial septal defect is due to increased flow through the pulmonic valve, making it remarkably similar to that of PS.
The difference lies in the intensity and splitting pattern of the S2 heart sound. The intensity of S2 should remain unchanged and may, in fact, be accentuated if pulmonary hypertension develops.
The S2 is fixed-split in a patient with an ASD. This differs from the widened split S2, seen in severe PS. Also, the murmur of an ASD does not increase in intensity with inspiration. Enlarge Hypertrophic obstructive cardiomyopathy HOCM The murmur of hypertrophic obstructive cardiomyopathy is important to detect due to its clinical implications; see Hypertrophic Obstructive Cardiomyopathy Topic Review. The murmur is high-pitched, crescendo-decrescendo, midsystolic murmur heard best at the left lower sternal border.
The important auscultatory features of HOCM that distinguish it from AS relate to dynamic auscultation, discussed in the respective section below. Enlarge Holosystolic Murmurs Holotsystolic murmurs — also known as pansystolic — include the murmurs of mitral regurgitation, tricuspid regurgitation and ventricular septal defects. Because the intensity of these murmurs is high immediately after the onset of S1, and extends to just before the S2, the S1 and S2 sounds are often overwhelmed by the murmur and may be difficult to hear.
Although the direction of radiation of the murmur depends on the nature of the mitral valve disease, it usually radiates to the axilla. The intensity of the murmur of MR does not increase with inspiration, helping to distinguish it from the murmur of tricuspid regurgitation. Enlarge Tricuspid regurgitation TR The murmur of tricuspid regurgitation is similar to that of MR in that it is high pitched and holosystolic; however, it is best heard at the left lower sternal border, and it radiates to the right lower sternal border.
The intensity significantly increases with inspiration, helping to distinguish it from MR. A ventricular septal defect produces yet another holosystolic murmur. Enlarge Late Systolic Murmurs The murmur of mitral or tricuspid valve prolapse is the only significant late systolic murmur. Tricuspid valve prolapse is relatively rare and usually not clinically significant.
Mitral valve prolapse produces a midsystolic click, typically followed by a uniform, high-pitched murmur. The murmur is actually due to MR that accompanies the mitral valve prolapse; thus, it is heard best at the cardiac apex. Mitral valve prolapse responds to dynamic auscultation. Enlarge Summary of Systolic Murmurs. Diastolic murmurs include aortic and pulmonic regurgitation early diastolic and mitral or tricuspid stenosis mid- to late-diastolic.
Tricuspid stenosis is very rare and is discussed further in the Tricuspid Stenosis Topic Review. As AR worsens in severity, the pressure between the LV and the aorta equalize much faster, and the murmur becomes significantly shorter. In patients with AR, an early diastolic rumble may also be heard at the apex due to the regurgitant jet striking the anterior leaflet of the mitral valve and causing it to vibrate.
This murmur is termed the Austin-Flint murmur.
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