From the Guidelines
Yes, it is possible to hear both Roger's murmur and Gibson murmur together in the same patient. Roger's murmur is a soft, mid-systolic murmur heard best at the left lower sternal border, typically associated with a small ventricular septal defect (VSD) 1. Gibson murmur, on the other hand, is a continuous "machinery" murmur heard best in the second left intercostal space or below the left clavicle, characteristic of patent ductus arteriosus (PDA). Since these murmurs originate from different cardiac defects, they can coexist when a patient has both a VSD and PDA simultaneously, which is not uncommon in congenital heart disease.
The distinction between these murmurs can be made based on their timing (Roger's being systolic and Gibson's being continuous throughout systole and diastole), location of maximum intensity, and quality. According to the guidelines for the management of patients with valvular heart disease, careful auscultation with attention to different areas of the chest wall and the timing within the cardiac cycle is essential for identifying both murmurs when they occur together 1. Echocardiography would typically be used to confirm the presence of both defects.
Some key points to consider when evaluating these murmurs include:
- The effect of respiration on murmur intensity, with right-sided murmurs generally increasing with inspiration and left-sided murmurs usually being louder during expiration 1
- The response of murmurs to the Valsalva maneuver, with most murmurs decreasing in length and intensity, except for the systolic murmur of HCM and MVP 1
- The change in murmur intensity with exercise, with murmurs caused by blood flow across normal or obstructed valves becoming louder with both isotonic and isometric exercise 1
- The use of pharmacological interventions, such as amyl nitrite inhalation, to distinguish between different types of murmurs 1.
Overall, careful evaluation and consideration of these factors are necessary to accurately diagnose and manage patients with Roger's murmur and Gibson murmur.
From the Research
Hearing the Rogers Murmur and Gibson Murmur Together
- There are no direct research papers that discuss the possibility of hearing the Rogers murmur together with the Gibson murmur 2, 3, 4, 5, 6.
- The provided studies focus on the diagnosis and management of ventricular septal defects, patent ductus arteriosus, and other congenital heart diseases, but do not mention the specific murmurs in question.
- The studies do discuss the importance of echocardiography in diagnosing and characterizing ventricular septal defects 5, 6, and the management of patent ductus arteriosus 3, 4, but do not provide information on the murmurs.
- Without further research, it is unclear if it is possible to hear the Rogers murmur and Gibson murmur together.