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Heart sounds of a healthy human female with a functional or "innocent" heart murmur after exercise. A functional murmur (innocent murmur, 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. [1]
A pansystolic heart murmur may be heard on auscultation of the chest. The murmur is usually of low frequency and best heard on the lower left sternal border. It increases with inspiration, and decreases with expiration: this is known as Carvallo's sign. However, the murmur may be inaudible due to the relatively low pressures in the right side ...
Decrescendo murmurs decrease in intensity over time. Crescendo-decrescendo murmurs have both shapes over time. These have progressive increase in intensity, peak, and progressive decrease in intensity. Crescendo–decrescendo murmurs resemble a diamond or kite shape. Location refers to where the heart murmur is usually heard best. There are ...
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Therefore, right-sided heart murmurs generally increase in intensity with inhalation. The decreased (more negative) intrathoracic pressure has an opposite effect on the left side of the heart, making it harder for the blood to exit into circulation. Therefore, left-sided murmurs generally decrease in intensity during inhalation.
Pulsus paradoxus is therefore an exaggeration or an increase in the fall of systolic BP beyond 10 mmHg during inspiration. [4] Normally during inspiration, a person's systolic blood pressure decreases by ≤10 mmHg [1] and heart rate slightly increases.
The paradoxical increase of the JVP with inspiration (instead of the expected decrease) is referred to as the Kussmaul sign, and indicates impaired filling of the right ventricle. The differential diagnosis of Kussmaul's sign includes constrictive pericarditis , restrictive cardiomyopathy , pericardial effusion , and severe right-sided heart ...
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