You should also be aware of and be able to identify a murmur that is called a continuous murmur. That term actually applies to the fact that the murmur continues through the second heart sound. So there is a systolic and a diastolic component. Classically, the sound of a patient with a patent ductus arteriosus. Let’s listen together in a patient that simulates that and use the carotid impulse to time systole, and listen at the upper left chest together.
[sounds]
That murmur is impressive and it’s easy to mimic [sounds]. You try it. [sounds]. The pathophysiology of that murmur that continues through the second sound is the fact that there is a gradient between the, in this case, the aorta and the pulmonary artery through the ductus, both in systole and diastole, and that is what generates the continuous type of murmur you heard. Let’s mimic it one more time [sounds]. A continuous murmur.
Continuous Murmur Animation
A continuous murmur begins in systole and continuous through the second sound into diastole. Such murmurs result from turbulent flow originating in blood vessels. Continuous murmurs may be due to rapid blood flow, such as the venous hum heard in children in the clavicular area. They may also be due to shunts from high to low pressure vessels, as seen in patients with patent ductus arteriosus. Finally, they may be due to localized arterial obstruction in patients who have critical stenosis without adequate collateral circulation. Note that the murmur continues through the second sound and is high frequency. Let us listen together. [sounds]