Aging may affect the location of the apical impulse, the pitch of heart sounds and murmurs, the stiffness of the arteries, and blood pressure. For example, the PMI is usually easily palpated in children and young adults; as the chest deepens in its anteroposterior (AP) diameter, the impulse gets harder to find. For the same reason, splitting of S2 may be harder to hear in older people as its pulmonic component becomes less audible. Furthermore, at some time during the life span, almost everyone has a heart murmur. Most murmurs occur without other evidence of cardiovascular abnormality and are considered normal variants. These common murmurs vary with age, and knowing their patterns helps you to distinguish normal from abnormal.
Murmurs may originate in large blood vessels as well as in the heart. The jugular venous hum, which is common in children, may still be heard through young adulthood. A second more important example is the cervical systolic murmur or bruit, which may be innocent in children but suspicious for atherosclerotic disease in adults.
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