Heart Murmur

Description

• Abnormal heart sounds created by turbulent flow across heart valves or vascular abnormalities
• Systolic murmurs are common findings in adults (15–44%) and children (80–96%)
• Stenotic lesions:
  • Pressure overload in the chamber preceding the valve, leading to hypertrophy of the chamber in an attempt to overcome the increased resistance
• Regurgitant lesions:
  • Volume overload of the chamber preceding the valve, leading to chamber dilatation in an attempt to accommodate the regurgitant blood volume
• Genetic abnormalities:
  • Congenital defects associated with abnormal cardiac blood flow

Etiology

• Aortic stenosis:
  • Rheumatic heart disease
  • Congenital bicuspid valve
  • Calcification
  • Prosthetic valve
• Aortic regurgitation:
  • Rheumatic heart disease
  • Endocarditis
  • Aortic dissection
  • Prosthetic valve
• Mitral stenosis:
  • Rheumatic heart disease
  • Rheumatologic disorders (systemic lupus erythematosus)
  • Calcification
  • Cardiac tumors (atrial myxoma)
  • Congenital
  • Prosthetic valve
• Mitral regurgitation, acute:
  • Endocarditis
  • Papillary muscle rupture or dysfunction
  • Rupture of chordae tendineae
  • Prosthetic valve
• Mitral regurgitation, chronic:
  • Rheumatic heart disease
  • Mitral valve prolapse
  • Connective tissue disease (Marfan syndrome)
• Mitral valve prolapse:
  • Congenital
  • Connective tissue disease
• Tricuspid stenosis:
  • Rheumatic heart disease
• Tricuspid regurgitation:
  • Rheumatic heart disease
  • Endocarditis
  • Pulmonary HTN
• Pericardial friction rub:
  • Pericarditis
  • Pericardial effusion
• Ventricular septal defect:
  • Congenital
  • Traumatic
  • Postinfarction
• Ventricular assist device:
  • Implantable pump supplements or replaces ventricular function

• Pulmonic stenosis:
  • Congenital
  • Maternal–fetal rubella exposure
  • Rheumatic heart disease
• Pulmonic regurgitation:
  • Congenital
  • Rheumatic heart disease
  • Pulmonary HTN
• Atrial septal defect:
  • Congenital
• Patent ductus arteriosus:
  • Congenital
  • Prematurity
  • Maternal–fetal rubella exposure
• Coarctation of the aorta:
  • Congenital
  • Turner syndrome
• Hypertrophic cardiomyopathy/idiopathic hypertrophic subaortic stenosis:
  • Congenital
  • Genetic predisposition