Clinical Note

Certain valve lesions and other anatomic defects can give rise to sounds other than the four just mentioned. For example, if the aortic valve fails to close properly (aortic regurgitation), blood will be forced across it in a retrograde manner during diastole. This flow will be turbulent and result in additional cardiac sounds collectively referred to as a murmur. A murmur is by definition a sustained sound that it not normally present. Although a regurgitant aortic valve will cause a diastolic murmur, a regurgitant mitral valve will cause a murmur during systole, because the inappropriate flow would be during the systolic period. The timing and quality of the murmurs help to identify the nature of the defect causing them. Sometimes the turbulent flow caused by a murmur is so intense that the low-frequency vibrations can be felt with the fingers on the chest wall. This is called a thrill. Other conditions, such as mitral value prolapse, can cause clicking sounds termed clicks.

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