Murmurs and Heart Sounds in Congestive Heart Failure

Pan-systolic murmurs are murmurs that are heard throughout systole of the ventricles.

Causes:

- Mitral regurgitation
- Tricuspid regurgitation ( usually difficult to detect)
- Ventricular Septal Defect
- Pulmonary stenosis
- Aortic stenosis

Pan-systolic murmurs heard in patients with congestive heart failure may be indicative of the causes of the heart failure. These murmurs may prove that there is insufficiency of the AV valves, a stenosis in the semilunar valves or a ventricular septal defect which led to the development of a heart failure.

There are other types of murmurs that may be heard in a patient with congestive heart failure. These can be grouped under diastolic murmurs. As the name suggests, these murmurs are heard during the diastole of the ventricles. They are caused by aortic regurgitation or pulmonary regurgitation (usually difficult to detect).

A physician should be alert for murmurs in patients with congestive heart failure as they can provide information about the cause of heart failure and also aid in the selection of therapy.

Third and Fourth Heart Sounds

As discussed in the previous PCL, 3rd and 4th heart sounds are detected in the presence of diseased valves. Hence in patients with congestive heart failure caused by diseased valves, S3 and/or S4 can be heard.

A point to note:
A third heart sound is not sensitive (24 percent) for heart failure, but it is highly specific (99 percent).

Contributed by John Lee