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Origin and clinical relevance of musical murmurs

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Abstract

Although our observations are limited to studies performed on a degenerated bioprosthetic valve that produced a musical murmur, we believe that they can be applied to musical murmurs caused by abnormal natural valves.

Several points regarding the characteristics of musical murmurs have been clarified.

  • 1.

    (1) A musical murmur results from a uniform periodic vibration of a cardiac structure.

  • 2.

    (2) A non-musical murmur results from turbulent blood flow which initiates random vibrations of adjacent structures. The broad spectrum of frequency of a non-musical murmur reflects the broad range of random fluctuations of blood velocity that characterizes turbulent blood flow.

  • 3.

    (3) The frequency, amplitude, and time of occurrence during systole or diastole of a musical murmur are dependent upon the hemodynamics in the vicinity of the vibrating structure. Variability of all of these characteristics of the murmur, therefore, may be expected.

  • 4.

    (4) Musical murmurs may have a purer tone at a site distal to the source than close to the source. This may reflect a superimposition of a broad spectrum of noise due to turbulence close to the valve. With distance from the valve, turbulence attenuates more than the sound-pressure fluctuations which are due to the uniform vibrations of the valve. A pure tone, uncontaminated by this broad spectrum of noise due to turbulence, therefore, is heard at some distance from the valve.

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From the Department of Medicine (Division of Cardiovascular Medicine) and the Department of Surgery, Henry Ford Hospital, Detroit, MI, U.S.A.

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