Doppler study of precordial musical murmurs

Am J Cardiol. 1989 Jun 1;63(18):1390-4. doi: 10.1016/0002-9149(89)91054-0.


Using phonocardiography, continuous- and pulsed-wave Doppler, 51 patients with precordial "musical" murmurs (49 with cardiac abnormalities) and 21 patients with noisy murmurs were examined. With M-mode echocardiography, fine fluttering of the structure generating the murmur was evident in 23 patients with musical murmurs and in 5 with noisy murmurs. A continuous-wave Doppler spectral signal characterized by parallel harmonics (Doppler musical signal) was evident in all patients with musical murmurs and in none with a noisy murmur. With pulsed-wave Doppler, the musical signal had less defined spectral features because of range ambiguity. Such a signal was experimentally reproduced by activating a diapason bathed in saline solution. The source of the musical murmur was established in all 51 patients by Doppler. The musical signal was associated with a valvular regurgitation signal in 36 patients and with a ventricular septal defect in 1 patient. The musical signal always disappeared when the pulsed-wave Doppler sample volume was placed 2 cm away from the generating structure. In 11 patients with musical murmur examined by color Doppler, no abnormal bidirectional flow signal was observed in the structures generating the signal. In 6 of the patients without valvular regurgitation, no flow disturbance was found. In conclusion, Doppler is valuable in determining the source of musical murmurs, and musical murmurs are caused by a vibrating structure even in the absence of flow turbulence.

MeSH terms

  • Aortic Valve Insufficiency / diagnosis
  • Coronary Circulation
  • Echocardiography, Doppler*
  • Heart Auscultation*
  • Heart Murmurs*
  • Heart Valve Diseases / diagnosis*
  • Heart Valve Prosthesis
  • Humans
  • Mitral Valve Insufficiency / diagnosis
  • Myocardial Contraction
  • Phonocardiography*