Audible Pulses: Their Nature and Typical Patterns
Understanding Abnormal Heart Sounds and Murmurs
Heartbeats are a fundamental part of life, with the human heart pumping approximately 100,000 times a day. However, sometimes, abnormal heart sounds and murmurs may be heard, which can indicate underlying heart conditions.
When blood flows through the heart chambers as valves open and close during the cardiac cycle, heart sounds are produced. The heart has four chambers: right atrium, right ventricle, left atrium, and left ventricle. The first heart sound, "lub", is caused by the closing of the mitral and tricuspid valves, while the second heart sound, "dub", is caused by the ventricles relaxing to receive blood from the atria.
However, there are four additional sounds that may be heard: the third and fourth heart sounds, and two low pitched, quieter sounds. The third heart sound is a low pitched sound caused by the rush of blood into the relaxing ventricle after the opening of the atrioventricular valve. The fourth heart sound is low pitched and very quiet, typically caused by the atrium contracting against a stiff ventricle.
Abnormal heart sounds and murmurs are primarily caused by turbulent blood flow within the heart or great vessels, often due to structural or functional abnormalities involving heart chambers or valves.
Causes of Abnormal Heart Sounds and Murmurs
- Physiological (Innocent) Causes
- Increased blood flow causing turbulence without structural heart disease, such as during pregnancy, anemia, fever, or in some children.
- Innocent murmurs like Still’s murmur or venous hum, common in children and generally harmless.
- Pathological Causes a. Valve Abnormalities
- Stenosis (narrowing) or regurgitation (leaking) of valves, such as aortic stenosis, mitral regurgitation, tricuspid valve disease, aortic or pulmonary regurgitation. b. Congenital Heart Defects
- Tetralogy of Fallot, ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus, coarctation of the aorta. c. Infections
- Endocarditis (infection of the heart's inner lining) can produce abnormal sounds. d. Other Structural Changes
- Cardiomyopathy (thickening or dilation of the heart muscle) causing turbulent flow.
- Alterations in Blood Flow Speed or Pressure
- High cardiac output states or acceleration of flow through vessels or chambers can also generate murmurs.
Significance of Abnormal Heart Sounds and Murmurs
- Diagnostic Clues: Murmurs often indicate the presence of underlying heart disease such as valve dysfunction, congenital defects, or cardiomyopathy, which can impact cardiac function.
- Symptoms Association: Pathological murmurs may be accompanied by symptoms like shortness of breath, fatigue, dizziness, chest pain, palpitations, swelling, or cyanosis, particularly in severe cases.
- Severity and Management: Some murmurs are benign and require no treatment, while others need further evaluation by cardiology and imaging like echocardiography to assess severity and decide treatment such as surgery or medication.
In conclusion, abnormal heart sounds and murmurs arise from turbulent blood flow due to valve problems, congenital defects, infections, or increased flow states. Their clinical significance ranges from innocent findings with no health risk to signs of critical heart conditions requiring intervention. Evaluation with a stethoscope followed by echocardiography is essential to determine the cause and appropriate management. Conditions such as hypertension, aortic stenosis, and cardiomyopathy may be associated with the fourth heart sound, while the third heart sound may indicate disease, such as congestive heart failure.
- These abnormalities in cardiovascular health could potentially lead to other heart diseases, such as aortic stenosis or mitral regurgitation.
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