Characteristics of pathological murmurs (5-7) * Diastolic, pansystolic
or late systolic * Usually loud (3/6 or more) * Associated with a thrill * Symptoms or signs of cardiac disease * Continuous * S1 inaudible or not single * Most do not change significantly on standing (the systolic murmur of the rare, but dangerous, hypertophic obstructive cardiomyopathy increases on standing) (7) * Examples: All murmurs caused by cardiac lesions.
The auscultation of the patient unveiled a 4/6 grade pansystolic
murmur which was best heard at the right and left second intercostal spaces.
A 2/6 pansystolic
murmur was heard on the mitral area and a 2/4 early diastolic murmur was heard in the intercostal space.
Hemodynamically stable, the examination revealed a new 4/6 pansystolic
murmur and a friction rub, with ECG with persistent ST-elevation in the inferior and lateral leads.
There was cardiomegaly, with an audible S3 and pansystolic
Significant regurgitation was defined as a regurgitation jet on the color and pulsed Doppler echocardiograms extending more than 2 cm behind the plane of the aortic, mitral or tricuspid valve and pandiastolic (aortic regurgitation) or pansystolic
(mitral and tricuspid regurgitation) regurgitant flow of more than 2 m/s on continuous wave Doppler (29,30).
On examination of the cardiovascular system, a positive Corrigan's sign (visibly pulsating carotids) was identified, as were pansystolic
and early diastolic heart mur murs, consistent with mitral and aortic regurgitation.
At presentation we detected 3/6 pansystolic
murmur at the apex and concomitant diastolic regurgitation at the left sternal border.
A Grade 2/6 to 3/6 apical pansystolic
murmur radiating to axilla was heard.
A grade 2/6 systolic ejection murmur was heard in the pulmonic area, and a grade 3/6 blowing pansystolic
murmur was heard at the apex.
On physical examination, 3/g pansystolic
murmur was heard at the apical area.
A 52-year-old man was referred to our hospital because of an apical first degree pansystolic
murmur heard on routine cardiac examination.