May 24, 2013

Heart Sound of the Month   

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Heart Sounds Contents   [Introduction]   [Answer]  
   

 
Signalment: 3 year old, Castrated male, Shetland Sheepdog
Presenting Complaint: Referral for murmur evaluation.
Presenting History

Free of clinical signs. Murmur first heard six weeks ago on routine physical exam.

Heart Sounds

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Download the sound file(s):
File 1: Heart Sound
(Left side: base)
File 2: Heart Sound
(Left side: apex)
       
    Auscultation Summary 

File 1: Heart Sound Details
 
  Stethescope Location: Left side: base   Learn more
 
  Heart Rate   Learn more
  Bradycardia: No    
  Tachycardia: No    
  Normal range: Yes    
  Heart Rhythm   Learn more
  Rhythm Character: Irregular    
  Premature Beats: No    
  Long Pauses: No    
  Extra Heart Sounds
  Murmur: Yes       Learn more
      Systolic: No    
      Diastolic: No    
      Continuous: Yes    
  Gallop: No       Learn more
  Systolic click: No    
  Other sounds: No    
  Lung Sounds
  Not Checked    
  Auscultation Diagnosis
  Loud continuous murmur with slight sinus arrhythmia 
  Clinical Diagnosis
  Patent ductus arteriousus 
 
Comment
  The murmur can be heard and seen (on the phonocardiogram) throughout all of systole and all of diastole, even though the intensity decreases in diastole, thus it is continuous. This is typical of a PDA. 
             
File 2: Heart Sound Details
 
  Stethescope Location: Left side: apex   Learn more
 
  Heart Rate   Learn more
  Bradycardia: No    
  Tachycardia: No    
  Normal range: Yes    
  Heart Rhythm   Learn more
  Rhythm Character: Regular    
  Premature Beats: No    
  Long Pauses: No    
  Extra Heart Sounds
  Murmur: Yes       Learn more
      Systolic: Yes    
      Diastolic: No    
      Continuous: No    
  Gallop: No       Learn more
  Systolic click: No    
  Other sounds: No    
  Lung Sounds
  Not Checked    
  Auscultation Diagnosis
  Soft early systolic murmur only over left apex. 
  Clinical Diagnosis
  Patent ductus arteriosus 
 
Comment
  This example emphasizes the importance of ausculting the heart thoroughly over both the apex and the base on both sides. Only a soft systolic murmur is heard over the left apex, likely due to mitral regurgitation, while the continuous murmur is not appreciated. The continuous PDA murmur is, however, very prominent over the left base. If only the apex were ausculted, the PDA could be missed.