Two types of clicks are common.  An early systolic (just after S1) high pitched click heard at the base of the heart and upper sternal border is frequently heard in association with the "opening snap" of the semilunar valves which are mildly to moderately stenotic.  Semilunar valves with severe stenosis and which are significantly thickened do not have enough motion to generate this high pitched early systolic sound.  A medium pitched variable mid-systolic click that is accentuated and moved back slightly in systole after standing up from a squat or after Valsalva manuever is commonly heard in association with mitral valve prolapse.

Heart Murmurs:

Strings of sounds together that are too long to be considered a single sound are termed murmurs.  While heart murmurs may be evidence of valvar stenosis, valvar insufficiency, intra-cardiac or intra-arterial shunting, or vessel obstruction, the vast majority of heart murmurs are benign, functional, and normal.  In fact the majority of infants and children   will have an innocent heart murmur at some time in their life.   It is important to evaluate murmurs based on multiple identifying characteristics such as: location, timing, intensity, duration, radiation, quality and frequency (pitch).

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