The murmur at the upper right sternal edge was certainly impressive, but now we want to go back and tune in, tune in to the heart sounds. We really have to concentrate, because the murmur was very intense. Let us listen for the heart sounds. Let us again have our timing device, that is, the carotid vessel, and all of us listen together at the upper right sternal edge, focusing and tuning in on heart sounds.
Ejection sound
Let us review the acoustic events at the upper right sternal edge. Following S1 there is an ejection sound. An ejection sound may arise from either a pliable, congenitally deformed semilunar valve or in association with a dilated great vessel. The fact that this ejection sound is heard at the upper right sternal edge makes it most likely aortic in origin. In contrast, to pulmonary ejection sounds, aortic ejection sounds do not show respiratory variation.
The ejection sound is followed by a systolic long, late peaking, crescendo-decrescendo murmur. The long length of the murmur is consistent with significant stenosis, as there is a gradient and hence, turbulence throughout most of systole.
Murmur
The ejection sound is followed by a systolic, long, late-peaking, crescendo-decrescendo murmur. The long length of the murmur is consistent with significant stenosis, as there is a gradient and, hence, turbulence throughout most of systole.
URSE sounds remedial
Let us interpret together the heart sounds at the upper right sternal edge. We will again use the diaphragm of the stethoscope, we’ll again use the carotid vessel as the timing device, and really concentrate on heart sounds.
The murmur is so impressive at the upper right sternal edge, it is truly difficult to define subtle heart sounds. We did hear the first sound and the second heart sound with the systolic murmur in between. But if we really concentrated, we could also hear an additional sound, and that sound occurred just after the first heart sound, and it is called an ejection sound. It has a clicking, high-frequency quality and it is tough to hear, because it occurs just as the murmur begins. It is tought to dissociate it from the murmur, but nonetheless, it was there, and what does it tell us? It tells us something is happening in the area of the aortic outflow. One of two things specifically, and that is: is there disease of the valve where that valve is popping up into a dome-type position in the aortic outflow tract at the level of the valve? Or, is it possible there are vibrations in the great vessel that is coming out of the left side, that is, the aorta?