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Left ventricular function can be assessed by determining the apical impulse. A normal or hyperdynamic apical impulse suggests good ejection fraction and primary MR. A displaced and sustained apical impulse suggests decreased ejection fraction and chronic and severe MR. This type of murmur is known as the Castex Murmur. Holosystolic (pansystolic)
The other type of heart murmur is due to a structural defect in the heart itself. [1] [5] Defects may be due to narrowing of one or more valves (stenosis), backflow of blood, through a leaky valve (regurgitation), or the presence of abnormal passages through which blood flows in or near the heart. [1]
The loudness of the murmur does not correlate well with the severity of regurgitation. It may be followed by a loud, palpable P 2, [6] heard best when lying on the left side. [7] A third heart sound is commonly heard. [6] Patients with mitral valve prolapse may have a holosystolic murmur or often a mid-to-late systolic click and a late systolic ...
The grading gives a number to the intensity from 1 to 6: [2] [3] The palpable murmur is known as thrill, which can be felt on grade 4 or higher. The murmur is only audible on listening carefully for some time. The murmur is faint but immediately audible on placing the stethoscope on the chest. A loud murmur readily audible but with no thrill. [4]
Patients with mitral valve regurgitation typically have a holosystolic murmur, meaning it lasts for the duration of systole. Now even though we said that left-sided heart failure can cause mitral regurgitation, it also goes the other way, mitral regurgitation can be a cause of left-sided heart failure.
Pansystolic (Holosystolic) murmur along lower left sternal border (depending upon the size of the defect) +/- palpable thrill (palpable turbulence of blood flow). Heart sounds are normal. Larger VSDs may cause a parasternal heave, a displaced apex beat (the palpable heartbeat moves laterally over time, as the heart enlarges).