Gibson murmur (machinery murmur): Long rumbling continuous (machinery) murmur occupying most of systole and diastole, most commonly localized in the second left interspace near the sternum.
Usually indicative of patent ductus arteriosus. The murmur results from continuous flow from aorta to pulmonary artery since aortic pressure is higher than pulmonary pressure throughout cardiac cycle.
History of the Gibson murmur
1847 – First recorded description in London Medical Gazette v.39. Post mortem discussion between Dr’s Babington, Gull and Williams on a ‘case of cyanosis dependent on patent ductus arteriosus‘ following admission to Guys Hospital, London in January 1847. Dr Babington read the case, confirming patent ductus arteriosus, to which Dr Williams replied:
…as a sure ground of diagnosis…of patent ductus arteriosus…the murmur accompanying the first sound of the heart is prolonged INTO the second, so that there is no cessation of this murmur before the second has already commenced. From this sign…he was able in two cases…to diagnosticate this lesion, and post-mortem examination proved the accuracy of this diagnosis.[1847 Vol IV pp824]
1906 – Gibson original description:
It persists throughout the second sound, and dies away gradually during the long pause. The murmur is distinctly rough and thrilling in its character. It begins, however, somewhat softly, and increases in intensity so as to reach its acme just about, or immediately after, the incidence of the second sound, and from that point gradually wanes till its termination.G. A. Gibson 1906
- George Alexander Gibson (1854–1913)
- Babington, Gull, Williams. Case of cyanosis dependent on patent ductus arteriosus. London Medical Gazette 1846-1847; 39(4): 822-824
- Gibson GA. Diseases of the heart and aorta. Edinburgh, 1898: 161 (Fig 51), 303, 310–312
- Gibson GA. A clinical lecture on persistent ductus arteriosus. Med Press Circular 1906; 132: 572-4.
- Robbins A, Zhang G. Name that murmur. LITFL 2019
myths behind the history