(1) Opening snap (OS). An opening snap of the mitral valve is frequently heard in mitraI stenosis. The opening snap arises from the stiff mitral valve's snapping toward the let~ ventricle in early diastole. The opening snap is best heard in the fourth intercostal space halfway between the apex and the left sternal border. The interval between S2 and the OS is related to the severity of mitral stenosis. The more severe the stenosis, the shorter the S2-OS interval.

（1)开瓣音（OS) 二尖瓣狭窄病人通常可听到二尖瓣开瓣音。它是舒张早期通往左心室的硬化二尖瓣发出的一种捻发音，在心尖和胸骨左缘间的第四肋间隙很清楚。S2和开瓣音间隔时间跟二尖瓣狭窄程度有关，狭窄越严重，S2-OS间期就越短。

(2) Ejection clicks. Ejection clicks are high-pitched sounds occurring in early systole. They are associated with stenosis of either the aortic or the pulmonic valve, with hypertension or dilatation of either the aorta or the pulmonary artery or both. Aortic clicks are best heard at the apex, while pulmonic clicks are most audible at the left. upoer sternal border. Pulmonic clicks vary with respiration and are best heararduring expiration. Aortic clicks do not vary with respiration.

（2)喷射性喀喇音 喷射性喀喇音音调高，出现于收缩早期，与主动脉瓣或肺动脉瓣狭窄有关，也与主动脉瓣或肺动脉瓣或两者的高血压或膨胀有关。主动脉瓣喀喇音在心尖区听得最清楚，肺动脉瓣喀喇音则在胸骨左上缘最能听到。肺动脉瓣喀喇音可随呼吸发生变化，在呼气时听得最清楚。呼吸不会导致主动脉瓣喀喇音变化。

(3) Midsystolic (nonejection) clicks. Midsystolic clicks often accompanied by a late systolic murmur occur m patients with prolapse of the posterior leaflet of the mitral valve. The clicks may result from sudden tensing of the chordae tendineae or snapping of the prolapsing leaflet. The clicks may be single or multiple and may occur at any time during systole, although they generally come later than ejection clicks.

（3)收缩中期（非喷射性)喀喇音 通常伴有晚期收缩期杂音，见于二尖瓣后小叶脱垂病人,缘于腱索的突然紧绷或小叶脱垂时的喀嚓声。喀喇音可呈单一或多样性。可出现于收缩期任何时候，但通常会晚于喷射性喀喇音。

6. Systolic murmurs.

6、收缩期杂音

Systolic murmurs are classified according to their time of occurrence, sound quality, and duration. The most fundamental distinction is between systolic ejection murmurs and pansystolic murmurs. Ejection murmurs ordinarily occur in midsystole. Early and late systolic murmurs also occur and should be distinguished from ejection murmurs. Ejection murmurs begin after S1 and are usually crescendo-decrescendo ("diamond-shaped'), ending before S2. Pansystolic murmurs begin with S1, extend throughout systole, and are characteristically uniform in intensity Systolic ejection murmurs have been likened to the chug of a steam engine laboring up a hill, while pansystolic murmurs have been likened to the high-pitched wail of the engine's whistle.

根据其出现时间、声音性质及持续时间对收缩期杂音进行分类。最基本是要分清收缩期喷射音和全收缩期杂音。喷射音一般出现在收缩中期。在收缩早期或晚期也会出现杂音，应与喷射音相区别。喷射音始于S1后，通常有渐强-渐弱特征，并于S2前结束。全收缩期杂音与S1同时开始，贯穿整个收缩期，它被比作蒸汽机爬山时发出的“嘎嚓”声，全收缩期杂音则被比作蒸气机气笛的尖啸声。医学全.在线.网.站.提供

(1) Systolic ejection murmurs (SEMs). SEMs begin after the semilunar (aortic and pulmonic) valves open at the end of isovolumic systole. Their intensity parallels the amount of blood being ejected through the stenosis, peaking in midsystole. SEMs arise in the following settings: aortic or pulmonic stenosis, dilatation of the aorta or pulmonary artery, distal to the valve, increased rate of ventricular ejection (heart block, fever, anemia, exercise, thyrotoxicosis), and healthy individuals.

(1)收缩期喷射音（SEM) 在isovolumic收缩期末,半月形（主动脉和肺动脉)瓣打开，随后出现收缩期喷射性杂音。其强度与喷过狭窄部位的血液量相当，在收缩中期达到最高。收缩期喷射音出现于下例情形中：主动脉瓣或肺动脉瓣狭窄；主动脉或肺动脉瓣远端扩张；心室喷射率增加；和健康人体。

(2) Pansyatolic murmurs. Pansystolic murmurs occur when blood flows through a ventricular septal defect, or retrograde through the mitral or tricuspid valve. The even intensity and long duration of these murmurs reflect the large pressure difference across the orifice where the sound originates. The murmur continues as long as pressure in the chamber of origin exceeds that in the recipient chamber.

(2) 全收缩期杂音 当血流经过室间隔缺损或反流经过二尖瓣或三尖瓣时发生全收缩期杂音。杂音的平均强度和长持续时间反映出声口压力差异很大。只要发出室压力超过接收室，杂音就会继续存在。

(3) Early and late systolic murmurs. Early systolic murmurs begin with or shortly after S1 and end by midsystole. They have been reported in: mitral stenosis (etiology unclear, either coexistent mitra) regurgitation or distortion of the mitral valve apparatus), small ventricular septal defects, and individuals without cardiac disease.医学 全在.线提供www.med126.com

(3) 收缩早期和晚期杂音 收缩期早期杂音伴随或略后于S1出现，至收缩中期结束。在下例病症中曾有此类杂音的报告：二尖瓣狭窄（病因不明，同时伴有二尖瓣反流或二尖瓣变形)；轻度室间隔缺损；及无心脏疾病个体。

Late systolic murmurs begin in midsystole and extend to or through S2. They may be heard in mitral valve prolapse (frequently accompanied by midsystolic clicks) or coarctation of the aorta.

收缩期晚期杂音始于收缩期中期，延至或贯穿S2。可在二尖瓣脱垂（通常伴有收缩中期喀喇音)或主动脉瓣缩缝时听到。

(4) Summary. Systolic murmurs arising from the right side of the heart generally increase with inspiration while those originating on the left side decrease or do not change. Many systolic murmurs are totally innocent (as in pregnant women, growing children, and individuals with abnormal chest configuration).

(4) 总结 原于心脏右侧的收缩期杂音一般随吸气增强；原于左侧的则减弱或无变化。很多收缩期杂音是完全无害的（如妊娠妇女、发育期儿童、胸腔结构异常者)。

Diastolic murmurs are classified according to their position in diastole as early, mid, or late. An alternative classification emphasizes etiology: regurgitant murmurs from semilunar insufficiency versus ventricular filling murmurs. Regurgitant murmurs are generally early diastolic whereas ventricular filling murmurs occur in mid and late diastole.

舒张期杂音依据其舒张部位分位早期、中期和晚期。另一种分类则着重于其病因：由半月瓣闭锁不全所致的回流性杂音对心室充盈性杂音。回流性杂音一般出现于舒张早期，而心室充盈性杂音一般出现于舒张中晚期。

(1) Early diastolic murmurs. Early murmurs begin immediately after S2. The most common causes are aortic or pulmonic valve regurgitation. The murmur is usually high-pitched and blowing in quality with a decrescendo configuration. The intensity of the murmur reflects the size of the valvular leak, the acoustic properties of the chest, and the pressure difference across the valve. The distinction between pulmonic and aortic regurgitation may be extremely hard to make and may require catheterization for definitive determination.

(1) 早期舒张性杂音 早期杂音紧随S2发生。最常见的原因是主动脉瓣或肺动脉瓣反流。杂音呈高音调、吹风样、渐降型。其强度提示瓣膜泄漏面积、胸腔声学特征、及穿过瓣膜的压力差异。肺动脉瓣和主动脉瓣反流的分辨很难，需通过插管才能确诊。

(2) Mid and late diastolic murmurs. Mid and late diastolic murmurs are produced by forward flow of blood through the AV (mitral and tricuspid) valves. They arise from either augmented blood flow or a stenosed valve. As a rule the murmur is low-pitched and rumbling in quality~ It does not begin until the valve from which it originates opens (sometimes with an audible snap) and ventricular pressure has fallen below atrial pressure in early diastole. Conditions in which mid or late diastolic murmurs may arise include: mitral or tricuspid stenosis, left atrial myxoma, mitral regurgitation (increased flow), and large left-to-right shunts (increased flow).

(2) 舒张中期和晚期杂音 舒张中晚期杂音是在血液前行经过AV（二尖瓣和三尖瓣)瓣膜时产生的，要么是因为血流的增加，要么是因为瓣膜变窄。杂音一般呈低音调、辘辘样，只有当产生杂音的瓣膜张开（有时可听到喀嚓声)、舒张早期心室压力降至低于心房压力后才会出现。可导致舒张中晚期杂音的病症包括：二尖瓣或三尖瓣狭窄；左心房粘液瘤；二尖瓣反流（流量增加)及大量的左-右分流（流量增加)。

8. Continuous murmurs.

Murmurs are considered continuous when they are audible throughout all phases of the cardiac cycle. They generally arise when a continuous pressure differential allows blood to flow constantly from a high to a low pressure area, as may occur in a variety of congenital defects, most commonly patent ductus arteriosus, anomalous origin of the left coronary artery, or coronary arteriovenous fistula. Other conditions that may cause continuous murmurs include ruptured aneurysm of a sinus of Valsalva, proximal coronary artery stenosis, and pulmonary artery branch stenosis.

整个心动周期都可以听到的杂音被称为连续性杂音。一般出现在持续压力差使血液从一高压区不断流向低压区时，也可以出现在一些有先天性缺陷的病，最常见的有动脉导管未闭、左冠状动脉起端异常，或冠状静脉动脉瘘。可能导致持续性杂音的其他病症有：瓦尔萨尔瓦动脉瘤的窦破裂，近端冠状动脉狭窄，及肺动脉支狭窄。

An analogous phenomenon is the venous hum, This continuous, low-pitched murmur results from increased velocity of venous blood flow. It is an innocent finding, usually heard in the lower anterior portion of the neck. Venous hum is accentuated by deep inspiration in most patients and may be obliterated by the Valsalva maneuver or by pressure on the internal jugular vein.

类似的一个现象是静脉嗡鸣音。这种持续的低音调杂音起源于静脉血流速的增加，对健康无害，可在颈前下部听到。多数病人在深吸气时静脉嗡鸣音明显，用瓦尔萨尔瓦手法或按压颈内静脉即或消除。