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Abstract
Continuous murmur is a peculiarity of cardiovascular auscultation, relatively rare, which often hides complex cardiovascular diseases. This article is a review of literature data related to the continuous murmurs accompanied by commenting and illustrating them through our own cases.
Recognizing of a continuous murmur and understanding the cardiovascular pathologies that it can hide, is a challenge in current practice.
* Keywords: continuous murmur, heart auscultation, diagnosis, incidence, congenital heart disease *
Cardiac auscultation is a fundamental step in diagnosing heart disease. This requires: a good technique and experience, as Froment R. said "auscultation (of the heart) is a music; which supposed a very long sensory education" [11].
Knowing the conditions that determinate continuous murmur, can facilitate recognition of this type of murmur and then establish the diagnosis [2,4,6].
Definition. The continuous murmur is the murmur that begins in systole and continues without interruption, encompassing the second sound, throughout diastole or part of thereof [2]. The murmur that disappears completely before the next first sound, is still considered continuous, if the systolic part of it continues without interruption during the second sound [2,4,6].
The continuous murmurs are often intense, rough and accompanied by quivering [7].
Depending on the location of the continuous murmur and characteristics of its components, a differential diagnosis can be made; for example continuous murmurs of patent ductus arteriosus is the loudest left infraclavicular with a more pronounced systolic component, whereas a coronary artery fistula can be heard anywhere in the heart area (depending on the origin and drainage) and diastolic component in this case are loudest.
The presence of a systolic-diastolic murmur (systolic murmur and diastolic murmur) so called a to-andfro murmur, is not a continuous murmur, being different, by separating the two murmurs through a small "silence". A to-and-fro murmur, involves two components: a systolic one, in which the blood flows in one direction, and a diastolic one in which the blood flows in the opposite direction, while those with true continuous murmur, the blood flows in the same direction in both systole and diastole [4].
Double murmur occurs most frequently in cases in which there is a valvular stenosis and a valvular regurgitation (aortic, mitral, tricuspid or pulmonary). This is due to a major reshuffle of valve...