A general theory of the causes of murmurs in the cardiovascular system

      This paper is only available as a PDF. To read, Please Download here.


      It is suggested that the classic theory that murmurs are due to turbulence in flowing blood is unlikely to be correct, as is another theory that they may be due to cavitation. A new theory concerning the cause of murmurs is offered. The postulates of the theory are:
      • 1.
        1. The bulk of the acoustical energy in murmurs is due to nearly periodic fluctuations in the wake found downstream of any appropriate obstacle and the characteristics of this type of flow are similar to those associated with Aeolian tones or orifice flow.
      • 2.
        2. The vast majority of murmurs are due to protuberances of minor to moderate size, to wall discontinuities of the heart, its valves and the larger vessels. These murmurs are greatly intensified by relatively small increases in the velocity of flowing blood.
      • 3.
        3. The position of listening as it relates to a column of moving blood modifies the perceived frequencies to a remarkable degree.
      • 4.
        4. Application of this theory to the known diverse characteristics of murmurs lends a unity to the understanding of their peculiarities.
      • 5.
        5. The behavior of blood flowing around and beyond any obstacle capable of generating a murmur is faithfully represented by the acoustical characteristics of the murmur so produced.
      • 6.
        6. Knowledge of the forces involved in nearly periodic wake fluctuations allows more complete understanding of the stresses that may lead to degeneration of cardiovascular structures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Reynolds O.
        An experimental investigation of the circumstances which determine whether the motion of water shall be direct or sinuous, and the law of resistance in parallel channels.
        Phil. Tr. Roy. Soc. 1883; 174: 935
        • Marwardi O.K.
        Rep. Prog. Physics. 1956; 19: 156
        • Lighthill M.J.
        On sound generated aerodynamically. I. General theory.
        in: 4th ed. Proc. Roy. Soc., London. A211. 1952: 564
        • Lighthill M.J.
        On sound generated aerodynamically. II. Turbulence as a source of sound.
        in: 4th ed. Proc. Roy. Soc., London. A222. 1954: 1
        • Curle N.
        The influence of solid boundaries upon aerodynamic sound.
        in: 4th ed. Proc. Roy. Soc., London. A231. 1955: 505
        • Rappaport M.B.
        • Sprague H.B.
        Physiologic and physical laws which govern auscultation, and their clinical application: the acoustic stethoscope and the electrical amplifying stethoscope.
        Am. Heart J. 1941; 21: 257
        • Phillips O.M.
        On the aerodynamic surface sound from a plane turbulent boundary layer.
        in: 4th ed. Proc. Roy. Soc., London. A234. 1956: 327
        • McDonald D.A.
        The occurrence of turbulent flow in the rabbit aorta.
        J. Physiol. 1952; 118: 340
        • Corcos G.M.
        • Liepman H.W.
        On the transmission through a fuselage wall of boundary layer noise.
        National Advisory Committee for Aeronautics, tech. memo 4139. 1958;
        • Willmarth W.W.
        Wall pressure fluctuations in a turbulent boundary layer.
        National Advisory Committee for Aeronautics, tech. note 4193. 1958;
        • Weyers P.F.R.
        On the measurement of acoustic radiation due to wall pressure deformation by turbulent flow.
        Guggenheim Aeronautics Laboratory, California Institute of Technology report. April, 1957;
        • Vennard J.K.
        Nature of cavitation; from cavitation in hydraulic structures.
        Tr. Am. Soc. Civ. Eng. 1947; 112: 1
        • Strasberg M.
        Gas bubbles as sources of sound in liquids.
        J. Acoust. Soc. America. 1956; 28: 20
        • Mellen R.H.
        An experimental study of the collapse of a spherical cavity in water.
        J. Acoust. Soc. America. 1956; 28: 447
        • Bruns D.L.
        • Rytand D.A.
        4th ed. Progress report. San Francisco Heart Association, Feb. 1954
        • Etkin B.
        • Korbacher G.K.
        • Keefe R.T.
        Acoustic radiation from a stationary cylinder in a fluid stream (aeolian tones).
        J. Acoust. Soc. America. 1957; 29: 30
        • Birkhoff G.
        • Zarantonello E.H.
        Jets, Wakes and Cavities.
        in: Academic Press, New York1957: 280-297
        • Roshko A.
        On the development of turbulent wakes from vortex streets.
        National Advisory Committee for Aeronautics, tech. note 2913. 1953;
        • Phillips O.M.
        The intensity of aeolian tones.
        J. Fluid Mech. 1956; 1: 607
        • Yudin E.Y.
        On vortex sound from rotating rods.
        National Advisory Committee for Aeronautics, tech. memo 1136. 1947;
        • Stowell E.Z.
        • Deming A.F.
        Vortex noise from rotating cylindrical rods.
        National Advisory Committee for Aeronautics, tech. note 519. 1935;
        • Gerrard J.H.
        Measurements of the sound from circular cylinders in an air stream.
        in: 4th ed. Physical Soc. London, Proc.B68. 1955: 453
        • Fage A.
        • Johansen F.C.
        On the flow of air behind an inclined flat plate of infinite span.
        in: 4th ed. Proc. Roy. Soc., London. A116. 1927: 170
        • Anderson A.B.C.
        A circular-orifice number describing dependency of primary pfeifenton frequency of differential pressure, gas density, on orifice diameter.
        J. Acoust. Soc. America. 1953; 25: 626
        • Johansen F.C.
        Flow through pipe orifices at low Reynolds numbers.
        in: 4th ed. Proc. Roy. Soc., London. A126. 1929: 231
        • Spivack H.N.
        Vortex frequency and flow pattern in the wake of two parallel cylinders at varied spacing normal to an air stream.
        J. Aero. Sc. 1946; 13: 289
        • Anderson A.B.C.
        Structure and velocity of periodic vortex-ring flow pattern of a primary pfeifenton (pipe tone) jet.
        J. Acoust. Soc. America. 1956; 27: 914
        • Anderson A.B.C.
        Vortex-ring structure-transition in a jet emitting discrete acoustical frequencies.
        J. Acoust. Soc. America. 1956; 28: 914
        • Anderson A.B.C.
        Metastable jet-tone states of jets from sharp-edged, circular pipe-like orifices.
        J. Acoust. Soc. America. 1955; 27: 13
        • Bondi S.
        Die Entstehung der Herzgerausche.
        Ergebn. d. inn. Med. 1936; 50: 308
        • von Karman T.
        J. Roy. Aero. Soc. 1937; 41: 1109
        • McDonald D.A.
        Murmurs in relation to turbulence and eddy formation in the circulation; from symposium on cardiovascular sound. 4th ed. Circulation. 16. 1957: 270
        • Callaway D.B.
        • Tyzzer F.G.
        • Hardy H.C.
        Resonant vibrations in a water-filled piping system.
        J. Acoust. Soc. America. 1951; 23: 224
        • Bruns D.L.
        • van der Hauwaert L.G.
        The aortic systolic murmur developing with increasing age.
        Brit. Heart J. 1958; 20: 370
        • Carstensen E.L.
        • Li K.
        • Schwan H.P.
        Determination of the acoustic properties of blood and its components.
        J. Acoust. Soc. America. 1953; 25: 286