Heart murmur resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

  • systolic murmur[1]
    • Ejection murmurs
      • Functional
        • Still's murmur and its adult variant
        • Flow murmur emanating from the root of the pulmonary artery
        • Murmur associated with high cardiac output states
        • Flow murmurs associated with aortic or pulmonary valvular insufficiency
      • Organic
        • Valvular aortic stenosis
        • Aortic sclerosis
        • Discrete subvalvular aortic stenosis (web or tunnel)
        • Supravalvular aortic stenosis
        • Hypertrophic obstructive cardiomyopathy
        • Pulmonary valvular stenosis
        • Pulmonary infundibular stenosis
        • Atrial septal defect
        • Tetralogy of Fallot
    • Regurgitant murmurs
      • Functional: none
      • Organic:
        • Mitral regurgitation:
          • Rheumatic
          • Papillary muscle dysfunction
          • Mitral valve prolapse
          • Acute
        • Tricuspid regurgitation:
          • Chronic
          • Acute
        • Ventricular septal defect
          • Roger's type (small and large)
            • Without pulmonary hypertension
            • With pulmonary hypertension
          • Slitlike
      • Extracardiac sounds simulating systolic heart murmurs
        • Subclavian (supraclavicular/brachiocephalic) murmur
        • Internal mammary soufflé
        • Carotid artery bruits
        • Coarctation of the aorta
        • Murmurs emanating from a dilated aortic or pulmonary artery root
        • Patent ductus arteriosus with pulmonary hypertension
  • diastolic murmur[2]
    • Aortic regurgitation
    • Pulmonary valve regurgitation
    • Mitral rumble
      • Obstruction to flow
        • Mitral stenosis (rheumatic, congenital)
        • Left atrial myxoma
        • Cor triatriatum
        • Localized pericardial constriction
      • Increased flow
        • Mitral regurgitation
        • Ventricular septal defect
        • Patent ductus arteriousus
        • Complete heart block
    • Tricuspid rumble
      • Obstruction to flow
        • Tricuspid stenosis (rheumatic, Ebstein's anomoly, carinoid)
        • Right atrial myxoma
        • Localized pericardial constriction
      • Increased flow
        • Atrial septal defect
        • Tricuspid regurgitation
  • continuous murmur [3]
    • THORACIC:
      • Precordial
        • Patent ductus arteriosus
        • Coronary arteriovenous fistulas
        • Sinus of Valsalva aneurysm ruptured into right cavities
        • Atrial septal defect associated with abnormalities that cause increased pressure in the left atrium
        • Left coronary artery origin from pulmonary artery anomaly
        • Continuous murmur at intern mammary artery
      • Extra Precordial
        • Coarctation of the aorta
        • Pulmonary atresia
        • Pulmonary arteriovenous fistula
        • Truncus arteriosus
        • Anomalies of origin of the pulmonary artery
    • EXTRATHORACIC:
      • Venous hum
      • Cruveilhier-Baumgarten sindrom
      • Sever arterial stenosis
      • Extrathoracic arteriovenos fistulas

Diagnosis

Shown below is an algorithm summarizing the Strategy for evaluating heart murmurs according the the ACC/AHA Guidelines for the Management of Patients With ValvularHeart Disease.

 
 
 
 
 
 
 
 
 
 
 
Cardiac murmur
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
systolic murmur
 
 
 
 
 
 
 
diastolic murmur
 
 
 
 
continuous murmur
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Midsystolic,
grade 2 or less
 
 
 
 
❑ Early systolic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Echocardiography
 
 
 
 
 
 
 
 
 
D02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E01
 
E02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E02
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. Walker HK, Hall WD, Hurst JW (1990). "Clinical Methods: The History, Physical, and Laboratory Examinations". PMID 21250186.
  2. Walker HK, Hall WD, Hurst JW (1990). "Clinical Methods: The History, Physical, and Laboratory Examinations". PMID 21250187.
  3. Ginghină C, Năstase OA, Ghiorghiu I, Egher L (2012). "Continuous murmur--the auscultatory expression of a variety of pathological conditions". J Med Life. 5 (1): 39–46. PMC 3307079. PMID 22574086.