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- I think sometimes it's helpful to pause
and go over terminology
because although I'd love to think that your doctor
talks to you in English all the time,
sometimes he talks to you in jargon.
So let's lay down some of the jargon.
What's a murmur?
A murmur is simply turbulence of flow
that the doctor can hear with his stethoscope.
Now what's that?
If you take your garden hose outside,
you got the garden hose running.
You put your hand on that hose,
you probably don't feel anything.
If you were to kink that,
you feel that shuddering in the line,
that's turbulent flow.
That's something in the system
which is disrupting normal laminar flow,
causing, if you will, eddy currents,
and the turbulence that is transferred into shuttering.
Now if you could get your ear on that garden hose,
you'd hear it.
And that's all a murmur is.
All a murmur means is turbulent flow.
(heart beating)
(heart beating loudly)
A loud murmur is not necessarily worse than a quiet murmur.
It just indicates that there may be a problem present.
Or the disturbance in flow may be so minor
that it's inconsequential, ok.
As far as valves are concerned,
we already mentioned the aortic valve.
A normal aortic valve has three leaflets
and they block the flow of blood
from regurgitating back into the heart.
The mitral valve has two leaflets
and they are called the anterior leaflet
and the posterior leaflet, very simply put.
If a valve is stuck shut, the common term
for that is that it is stenotic, or has a stenosis,
does not open all the way normally.
If a valve is leaking,
it can be called insufficient,
because it isn't sufficiently stopping the flow,
so it is insufficient,
or sometimes because a flow that has been ejected
is regurgitating back through the valve,
it's called a regurgitant valve.
So you may hear someone talk about aortic stenosis,
aortic insufficiency, or aortic regurgitation,
the latter two being the same,
mitral stenosis, mitral insufficiency,
or mitral regurgitation, both of which are the same.
And they come in degrees of severity.
Let's take one step further with the mitral valve
because the mitral valve is a very complex structure.
I'ma give you a crude analogy.
If we have a circular train tunnel,
and I take two parachutes and tack the periphery of those
up against the walls of the train tunnel,
and I've got hold of the strings of that parachute,
and wind comes towards me,
they're gonna fold back against the wall of the tunnel
and the wind's gonna come through.
Cool.
If the wind's going the other way,
and I hold tight,
those parachutes are gonna meet in the middle
and airflow is gonna stop.
Now that mitral valve, because it's complex,
can leak for all sorts of reasons.
If the tunnel is much bigger
than the chutes are,
they're not gonna meet in the middle,
no matter how hard I hold,
they're gonna leak.
If I don't hold, if I let go
of the cords,
which are called the chordae tindineae of the mitral valve,
that valve's gonna leak.
If the cords break or rupture,
that valve's gonna leak.
So it can leak for all sorts of different reasons.
It can leak because
where it's anchored gets too big,
the chordae tindineae break,
or the muscle that's holding the chordae tindineae
gets loose,
or the mitral valve itself gets destroyed
by some disease process that causes it to shrink back.
So you'll hear your doctor talk
about aortic stenosis, aortic insufficiency,
mitral stenosis, and mitral insufficiency,
but they may have different causes,
they're various causes of each of those disorders.
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