7th March 2024

Background

An appreciation of the four chambers of the heart (see image below) and their orientation in the body will facilitate understanding of the location of murmurs and their radiation. Cardiac murmurs are heard loudest at the area above the respective valve and radiate in the direction of the turbulent flow. Systolic and diastolic murmurs are summarised in Tables 1 and 2.

To understand heart valve disorders, the following points are to be kept in mind for the MRCP:

• Blood normally moves towards ventricles in diastole
• Blood normally moves away from ventricles in systole
• The left sided circulation is a high-pressure system and the right side is a low-pressure system
• Stenosis produces pressure overload on the place from where blood is going
• Regurgitation produces volume overload on the place where it is coming back to 
• Ventricles hypertrophy in response to pressure overload and dilate in response to volume overload

Table 1. Diastolic murmurs 

Table 2. Systolic murmurs 

Image Source: Wikimedia Commons (2006). Heart, Licensed under a creative commons licence. Available for free at: https://simple.wikipedia.org/wiki/Heart (Accessed: 25 January 2024).