Continuous Heart Murmurs

Normal physiological murmur in children, rare in adults.
It is due to the rush of blood from the jugular veins into the superior vena cava.
May be loud and roaring with a palpable thrill.
Usually best heard on the right side of the neck, just over the clavicle.
When the murmur is also audible at the right sternal border, over the sternum itself, or on the left sternal border, it can be mistaken for the murmur of a patent ductus arteriosus, or for a to-and-fro aortic stenosis/insuffficiency murmur.
It can be obliterated by pressure over the jugular vein above the point of maximal murmur.
It can also decrease or disappear by changing from the sitting to the supine position.

Systolic-diastolic murmur that can be heard over one or both breasts
It is usually discovered in late pregnancy and during postpartum lactation
It typically disappears at the end of lactation
It can also be present during adolescence
It is best heard directly over the breast
Pressure with a finger or stethoscope in the area where the souffle is best heard may make it disappear
The origin is probably arterial, which explains the fact that the systolic component begins after a slight delay following the first heart sound
It is high pitched
Auscultation suggests that it is superficial
The character may vary from day to day

Reference: Tabatznik B, Randall TW, Hersch C. The mammary souffle of pregnancy and lactation. Circulation 22:1069, 1960

Other causes of continuous murmurs:

The contents and links on this page were last verified on July 23, 2003.