Heart murmur history and symptoms

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	Heart murmur Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Echocardiography
Treatment
Medical Therapy
Case Studies
Case #1
Heart murmur history and symptoms On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Heart murmur history and symptoms All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Heart murmur history and symptoms
CDC on Heart murmur history and symptoms
Heart murmur history and symptoms in the news
Blogs on Heart murmur history and symptoms
Directions to Hospitals Treating Heart murmur
Risk calculators and risk factors for Heart murmur history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD [2]

Overview

Many times, the person experiencing heart murmur may not be aware of anything. But heart murmur can be associated with other things such as tightness in the chest, shortness of breath, dizziness or lightheadedness. Depending on the cause of the murmur, these symptoms may be different.

History and Symptoms

The symptoms of heart murmur depend on the cause of the murmur.


Disease	Clinical features
Disease	Signs	Symptoms
Aortic stenosis	Vitals Narrow pulse pressure.^[1]^[2] Pulsus parvus et tardus.^[3] Pulsus bisferiens with mixed aortic stenosis and aortic regurgitation.^[4] Delayed carotid upstroke (apical-carotid delay) is present. ^[5] Pulsus alternans.^[6] Heart laterally displaced apical impulse.^[7]^[8] Systolic thrill at the right second intercostal space, in the jugular notch and along the carotid arteries.^[9] paradoxical splitting of S2 is present with A2 taking place after P2..^[10]^[8]^[11] the murmur is Crescendo-decrescendo type of ejection systolic murmur.^[12]^[8] Lungs In a patient with Aortic Stenosis, Pulmonary rales may be present when congestive heart failure has developed.^[13]^[14]^[8]	Symptoms by Age Group Symptoms in Adults^[15]^[16]^[17]^[18] Breathlessness with activity Chest pain, which resembles what is known as angina-type pain The pain is crushing, squeezing, pressure or tightness in nature The pain increases with exercise, relieved with rest. Fainting, weakness, or dizziness with activity Sensation of feeling the heart beat (palpitations) Symptoms in Infants and Children The following symptoms were observed in infants and children with aortic stenosis.^[19]^[20]^[21] Becoming tired or fatigued with exertion more easily than others (in mild cases) Serious breathing problems that develop within days or weeks of birth (in severe cases) Extreme fatigue Sweating Pale skin Fast breathing They may also be smaller than other children their age Children with mild or moderate aortic stenosis may get worse as they get older. They also run the risk of developing an infection of the heart valves (bacterial endocarditis).
MS	heart^[22]^[23]^[24] Jugular vein distension Apical impulse displaced laterally or not palpable Diastolic thrill at the apex Signs of heart failure in severe case the murmur will be Diastolic murmur, Low pitched, Opening snap followed by decrescendo-crescendo rumbling murmur.	Dyspnea on exertion Paroxysmal nocturnal dyspnea Orthopnea New onset atrial fibrillation
Mitral regurgitation		Acute or Decompensated Mitral Regurgitation volume overload with subsequent pulmonary congestion in addition to the decreased cardiac output. Symptoms include:^[25]^[26]^[27] Shortness of breath Orthopnea Paroxysmal nocturnal dyspnea Exercise intolerance Fatigue Lightheadedness Cough Cardiovascular collapse with shock (cardiogenic shock). Chronic Compensated Mitral Regurgitation Individuals with chronic compensated MR may be asymptomatic, with a normal exercise tolerance and no evidence of heart failure. Palpitations due to the dilatation of the left atrium.^[28]^[29]^[30]

References

↑ Bermejo J (2005). "The effects of hypertension on aortic valve stenosis". Heart. 91 (3): 280–2. doi:10.1136/hrt.2004.041749. PMC 1768786. PMID 15710699.
↑ J. BERGERON, W. H. ABELMANN, H. VAZQUEZ-MILAN & L. B. ELLIS (1954). "Aortic stenosis; clinical manifestations and course of the disease; review of one hundred proved cases". A.M.A. archives of internal medicine. 94 (6): 911–924. PMID 13217489. Unknown parameter |month= ignored (help)
↑ Etchells E, Bell C, Robb K (1997). "Does this patient have an abnormal systolic murmur?". JAMA : the Journal of the American Medical Association. 277 (7): 564–71. PMID 9032164. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ FLEMING PR (1957). "The mechanism of the pulsus bisferiens". Br Heart J. 19 (4): 519–24. PMC 503962. PMID 13471818.
↑ Blase A. Carabello & Walter J. Paulus (2009). "Aortic stenosis". Lancet (London, England). 373 (9667): 956–966. doi:10.1016/S0140-6736(09)60211-7. PMID 19232707. Unknown parameter |month= ignored (help)
↑ R. H. Swanton, B. S. Jenkins, I. A. Brooksby & M. M. Webb-Peploe (1976). "An analysis of pulsus alternans in aortic stenosis". European journal of cardiology. 4 (1): 39–47. PMID 1261578. Unknown parameter |month= ignored (help)
↑ S. J. Galloway, W. J. Casarella & P. M. Shimkin (1974). "Vascular malformations of the right colon as a cause of bleeding in patients with aortic stenosis". Radiology. 113 (1): 11–15. doi:10.1148/113.1.11. PMID 4547644. Unknown parameter |month= ignored (help)
↑ ^8.0 ^8.1 ^8.2 ^8.3 Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010). "Valvular heart disease: diagnosis and management". Mayo Clin Proc. 85 (5): 483–500. doi:10.4065/mcp.2009.0706. PMC 2861980. PMID 20435842.
↑ S. J. Galloway, W. J. Casarella & P. M. Shimkin (1974). "Vascular malformations of the right colon as a cause of bleeding in patients with aortic stenosis". Radiology. 113 (1): 11–15. doi:10.1148/113.1.11. PMID 4547644. Unknown parameter |month= ignored (help)
↑ Ilias Maglogiannis, Euripidis Loukis, Elias Zafiropoulos & Antonis Stasis (2009). "Support Vectors Machine-based identification of heart valve diseases using heart sounds". Computer methods and programs in biomedicine. 95 (1): 47–61. doi:10.1016/j.cmpb.2009.01.003. PMID 19269056. Unknown parameter |month= ignored (help)
↑ Chance M. Witt, William R. Miranda & Darrell B. Newman (2016). "The maverick heart sound". Heart (British Cardiac Society). 102 (13): 1008. doi:10.1136/heartjnl-2015-309131. PMID 26919867. Unknown parameter |month= ignored (help)
↑ Atsuko Furukawa, Yukio Abe, Makoto Ito, Chiharu Tanaka, Kazato Ito, Ryushi Komatsu, Kazuo Haze, Takahiko Naruko, Minoru Yoshiyama & Junichi Yoshikawa (2017). "Prediction of aortic stenosis-related events in patients with systolic ejection murmur using pocket-sized echocardiography". Journal of cardiology. 69 (1): 189–194. doi:10.1016/j.jjcc.2016.02.021. PMID 27012751. Unknown parameter |month= ignored (help)
↑ Lennart van Gils, Marie-Annick Clavel, Mara Vollema, Victoria Delgado, Tamim Nazif, Ernest Spitzer, Rebecca Hahn, Jeroen Bax, Martin Leon, Philippe Pibarot & Nicolas Van Mieghem (2016). "TCT-819 Clinical Outcome in Patients with Heart Failure and Moderate Aortic Stenosis". Journal of the American College of Cardiology. 68 (18S): B331–B332. doi:10.1016/j.jacc.2016.09.910. PMID 27970209. Unknown parameter |month= ignored (help)
↑ Ross J, Braunwald E (1968). "Aortic stenosis". Circulation. 38 (1 Suppl): 61–7. PMID 4894151.
↑ Rajani R, Rimington H, Chambers JB (2010). "Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms". Heart. 96 (9): 689–95. doi:10.1136/hrt.2009.181644. PMID 20424150.
↑ Amato MC, Moffa PJ, Werner KE, Ramires JA (2001). "Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing". Heart. 86 (4): 381–6. PMC 1729928. PMID 11559673.
↑ Das P, Pocock C, Chambers J (2000). "The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination". QJM. 93 (10): 685–8. PMID 11029480.
↑ Park SJ, Enriquez-Sarano M, Chang SA, Choi JO, Lee SC, Park SW; et al. (2013). "Hemodynamic patterns for symptomatic presentations of severe aortic stenosis". JACC Cardiovasc Imaging. 6 (2): 137–46. doi:10.1016/j.jcmg.2012.10.013. PMID 23489526.
↑ Mody MR, Nadas AS, Bernhard WF (1967). "Aortic stenosis in infants". N Engl J Med. 276 (15): 832–8. doi:10.1056/NEJM196704132761503. PMID 6020739.
↑ ONGLEY PA, NADAS AS, PAUL MH, RUDOLPH AM, STARKEY GW (1958). "Aortic stenosis in infants and children". Pediatrics. 21 (2): 207–21. PMID 13505014.
↑ Yun SW (2011). "Congenital heart disease in the newborn requiring early intervention". Korean J Pediatr. 54 (5): 183–91. doi:10.3345/kjp.2011.54.5.183. PMC 3145901. PMID 21829408.
↑ Nassar PN, Hamdan RH (2011). "Cor Triatriatum Sinistrum: Classification and Imaging Modalities". Eur J Cardiovasc Med. 1 (3): 84–87. doi:10.5083/ejcm.20424884.21. PMC 3286827. PMID 22379596.
↑ Roudaut R, Serri K, Lafitte S (2007). "Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations". Heart. 93 (1): 137–42. doi:10.1136/hrt.2005.071183. PMC 1861363. PMID 17170355.
↑ Apostolakis EE, Baikoussis NG (2009). "Methods of estimation of mitral valve regurgitation for the cardiac surgeon". J Cardiothorac Surg. 4: 34. doi:10.1186/1749-8090-4-34. PMC 2723095. PMID 19604402.
↑ Enriquez-Sarano M, Akins CW, Vahanian A (2009). "Mitral regurgitation". Lancet. 373 (9672): 1382–94. doi:10.1016/S0140-6736(09)60692-9. PMID 19356795.
↑ Birnbaum Y, Chamoun AJ, Conti VR, Uretsky BF (2002). "Mitral regurgitation following acute myocardial infarction". Coron Artery Dis. 13 (6): 337–44. PMID 12436029.
↑ Iung B (2003). "Management of ischaemic mitral regurgitation". Heart. 89 (4): 459–64. PMC 1769268. PMID 12639884.
↑ Madesis A, Tsakiridis K, Zarogoulidis P, Katsikogiannis N, Machairiotis N, Kougioumtzi I; et al. (2014). "Review of mitral valve insufficiency: repair or replacement". J Thorac Dis. 6 Suppl 1: S39–51. doi:10.3978/j.issn.2072-1439.2013.10.20. PMC 3966162. PMID 24672698.
↑ Sparano DM, Ward RP (2012). "Management of asymptomatic, severe mitral regurgitation". Curr Treat Options Cardiovasc Med. 14 (6): 575–83. doi:10.1007/s11936-012-0207-4. PMID 22961273.
↑ Mokadam NA, Stout KK, Verrier ED (2011). "Management of acute regurgitation in left-sided cardiac valves". Tex Heart Inst J. 38 (1): 9–19. PMC 3060740. PMID 21423463.

Template:WH Template:WS

[pmid15710699-1] Bermejo J (2005). "The effects of hypertension on aortic valve stenosis". Heart. 91 (3): 280–2. doi:10.1136/hrt.2004.041749. PMC 1768786. PMID 15710699.

[2] J. BERGERON, W. H. ABELMANN, H. VAZQUEZ-MILAN & L. B. ELLIS (1954). "Aortic stenosis; clinical manifestations and course of the disease; review of one hundred proved cases". A.M.A. archives of internal medicine. 94 (6): 911–924. PMID 13217489. Unknown parameter |month= ignored (help)

[pmid90321642-3] Etchells E, Bell C, Robb K (1997). "Does this patient have an abnormal systolic murmur?". JAMA : the Journal of the American Medical Association. 277 (7): 564–71. PMID 9032164. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)

[pmid134718182-4] FLEMING PR (1957). "The mechanism of the pulsus bisferiens". Br Heart J. 19 (4): 519–24. PMC 503962. PMID 13471818.

[5] Blase A. Carabello & Walter J. Paulus (2009). "Aortic stenosis". Lancet (London, England). 373 (9667): 956–966. doi:10.1016/S0140-6736(09)60211-7. PMID 19232707. Unknown parameter |month= ignored (help)

[6] R. H. Swanton, B. S. Jenkins, I. A. Brooksby & M. M. Webb-Peploe (1976). "An analysis of pulsus alternans in aortic stenosis". European journal of cardiology. 4 (1): 39–47. PMID 1261578. Unknown parameter |month= ignored (help)

[7] S. J. Galloway, W. J. Casarella & P. M. Shimkin (1974). "Vascular malformations of the right colon as a cause of bleeding in patients with aortic stenosis". Radiology. 113 (1): 11–15. doi:10.1148/113.1.11. PMID 4547644. Unknown parameter |month= ignored (help)

[pmid204358422-8] 8.0 ^8.1 ^8.2 ^8.3 Maganti K, Rigolin VH, Sarano ME, Bonow RO (2010). "Valvular heart disease: diagnosis and management". Mayo Clin Proc. 85 (5): 483–500. doi:10.4065/mcp.2009.0706. PMC 2861980. PMID 20435842.

[9] S. J. Galloway, W. J. Casarella & P. M. Shimkin (1974). "Vascular malformations of the right colon as a cause of bleeding in patients with aortic stenosis". Radiology. 113 (1): 11–15. doi:10.1148/113.1.11. PMID 4547644. Unknown parameter |month= ignored (help)

[10] Ilias Maglogiannis, Euripidis Loukis, Elias Zafiropoulos & Antonis Stasis (2009). "Support Vectors Machine-based identification of heart valve diseases using heart sounds". Computer methods and programs in biomedicine. 95 (1): 47–61. doi:10.1016/j.cmpb.2009.01.003. PMID 19269056. Unknown parameter |month= ignored (help)

[11] Chance M. Witt, William R. Miranda & Darrell B. Newman (2016). "The maverick heart sound". Heart (British Cardiac Society). 102 (13): 1008. doi:10.1136/heartjnl-2015-309131. PMID 26919867. Unknown parameter |month= ignored (help)

[12] Atsuko Furukawa, Yukio Abe, Makoto Ito, Chiharu Tanaka, Kazato Ito, Ryushi Komatsu, Kazuo Haze, Takahiko Naruko, Minoru Yoshiyama & Junichi Yoshikawa (2017). "Prediction of aortic stenosis-related events in patients with systolic ejection murmur using pocket-sized echocardiography". Journal of cardiology. 69 (1): 189–194. doi:10.1016/j.jjcc.2016.02.021. PMID 27012751. Unknown parameter |month= ignored (help)

[13] Lennart van Gils, Marie-Annick Clavel, Mara Vollema, Victoria Delgado, Tamim Nazif, Ernest Spitzer, Rebecca Hahn, Jeroen Bax, Martin Leon, Philippe Pibarot & Nicolas Van Mieghem (2016). "TCT-819 Clinical Outcome in Patients with Heart Failure and Moderate Aortic Stenosis". Journal of the American College of Cardiology. 68 (18S): B331–B332. doi:10.1016/j.jacc.2016.09.910. PMID 27970209. Unknown parameter |month= ignored (help)

[pmid48941512-14] Ross J, Braunwald E (1968). "Aortic stenosis". Circulation. 38 (1 Suppl): 61–7. PMID 4894151.

[pmid204241502-15] Rajani R, Rimington H, Chambers JB (2010). "Treadmill exercise in apparently asymptomatic patients with moderate or severe aortic stenosis: relationship between cardiac index and revealed symptoms". Heart. 96 (9): 689–95. doi:10.1136/hrt.2009.181644. PMID 20424150.

[pmid115596732-16] Amato MC, Moffa PJ, Werner KE, Ramires JA (2001). "Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing". Heart. 86 (4): 381–6. PMC 1729928. PMID 11559673.

[pmid110294802-17] Das P, Pocock C, Chambers J (2000). "The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination". QJM. 93 (10): 685–8. PMID 11029480.

[pmid234895262-18] Park SJ, Enriquez-Sarano M, Chang SA, Choi JO, Lee SC, Park SW; et al. (2013). "Hemodynamic patterns for symptomatic presentations of severe aortic stenosis". JACC Cardiovasc Imaging. 6 (2): 137–46. doi:10.1016/j.jcmg.2012.10.013. PMID 23489526.

[pmid60207392-19] Mody MR, Nadas AS, Bernhard WF (1967). "Aortic stenosis in infants". N Engl J Med. 276 (15): 832–8. doi:10.1056/NEJM196704132761503. PMID 6020739.

[pmid135050142-20] ONGLEY PA, NADAS AS, PAUL MH, RUDOLPH AM, STARKEY GW (1958). "Aortic stenosis in infants and children". Pediatrics. 21 (2): 207–21. PMID 13505014.

[pmid218294082-21] Yun SW (2011). "Congenital heart disease in the newborn requiring early intervention". Korean J Pediatr. 54 (5): 183–91. doi:10.3345/kjp.2011.54.5.183. PMC 3145901. PMID 21829408.

[pmid22379596-22] Nassar PN, Hamdan RH (2011). "Cor Triatriatum Sinistrum: Classification and Imaging Modalities". Eur J Cardiovasc Med. 1 (3): 84–87. doi:10.5083/ejcm.20424884.21. PMC 3286827. PMID 22379596.

[pmid17170355-23] Roudaut R, Serri K, Lafitte S (2007). "Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations". Heart. 93 (1): 137–42. doi:10.1136/hrt.2005.071183. PMC 1861363. PMID 17170355.

[pmid19604402-24] Apostolakis EE, Baikoussis NG (2009). "Methods of estimation of mitral valve regurgitation for the cardiac surgeon". J Cardiothorac Surg. 4: 34. doi:10.1186/1749-8090-4-34. PMC 2723095. PMID 19604402.

[pmid19356795-25] Enriquez-Sarano M, Akins CW, Vahanian A (2009). "Mitral regurgitation". Lancet. 373 (9672): 1382–94. doi:10.1016/S0140-6736(09)60692-9. PMID 19356795.

[pmid12436029-26] Birnbaum Y, Chamoun AJ, Conti VR, Uretsky BF (2002). "Mitral regurgitation following acute myocardial infarction". Coron Artery Dis. 13 (6): 337–44. PMID 12436029.

[pmid12639884-27] Iung B (2003). "Management of ischaemic mitral regurgitation". Heart. 89 (4): 459–64. PMC 1769268. PMID 12639884.

[pmid24672698-28] Madesis A, Tsakiridis K, Zarogoulidis P, Katsikogiannis N, Machairiotis N, Kougioumtzi I; et al. (2014). "Review of mitral valve insufficiency: repair or replacement". J Thorac Dis. 6 Suppl 1: S39–51. doi:10.3978/j.issn.2072-1439.2013.10.20. PMC 3966162. PMID 24672698.

[pmid22961273-29] Sparano DM, Ward RP (2012). "Management of asymptomatic, severe mitral regurgitation". Curr Treat Options Cardiovasc Med. 14 (6): 575–83. doi:10.1007/s11936-012-0207-4. PMID 22961273.

[pmid21423463-30] Mokadam NA, Stout KK, Verrier ED (2011). "Management of acute regurgitation in left-sided cardiac valves". Tex Heart Inst J. 38 (1): 9–19. PMC 3060740. PMID 21423463.

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Heart murmur history and symptoms

Overview

History and Symptoms

Chronic Compensated Mitral Regurgitation

References

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