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If a murmur is present, it will be categorized as one of three types, depending on when it occurs in the cardiac cycle:
- Systolic. Murmurs that occur during the heart’s muscular contraction phase (systole) during which blood is pumped from the heart. Systolic murmurs are further described as early systolic, mid-systolic, late systolic or holosystolic, referring to when they occur during the contraction period. Systolic murmurs may be innocent or may signal potential problems such as aortic stenosis or mitral regurgitation.
- Diastolic. Murmurs that occur during the heart’s resting phase (diastole), during which the heart takes in nourishment from oxygen-rich blood. Diastolic murmurs are further classified as early diastolic, mid-diastolic or late diastolic (presystolic). All diastolic murmurs are clinically significant, requiring further investigation to rule out aortic regurgitation or mitral stenosis.
- Continuous. Murmurs that occur through both the systolic and diastolic cycles. Continuous murmurs may be innocent and occur in healthy children and pregnant women. However, they may suggest the presence of cardiovascular problems (such as patent ductus arteriosus). Most continuous murmurs are subject to further evaluation.
A heart murmur may also be classified according to how loud it is, as well as its location in the chest. Based on a scale from one to six, with higher designations being more intense (louder), a physician may label a heart murmur as “grade 1,” “grade 2” and so forth. However, since listening to the heart is the physician’s primary tool for distinguishing heart murmurs, such labeling is subjective and not precisely measurable. Heart murmurs are also described by their location in the chest, from their radiation or transmission (to neck or back), and their pitch (low frequency or high pitch, etc.).
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