Heart Murmur

Basics

Description

  • Abnormal heart sounds created by turbulent blood flow within the heart
  • Heart murmurs can be systolic, diastolic, or continuous
  • 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
    • Connective tissue disease:
      • Marfan syndrome
      • Ehlers–Danlos syndrome
    • Syphilitic aortitis
    • Ankylosing spondylitis
  • 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
    • Dilated cardiomyopathy
    • Ischemic heart disease
    • Radiation-induced valve damage
  • Mitral valve prolapse:
    • Congenital
    • Connective tissue disease
    • Myxomatous degeneration
    • Autonomic dysfunction
  • Tricuspid stenosis:
    • Rheumatic heart disease
    • Carcinoid syndrome
    • Congenital
    • Prosthetic valve
  • Tricuspid regurgitation:
    • Rheumatic heart disease
    • Endocarditis
    • Pulmonary HTN
    • Right ventricular dilation
    • Congenital Ebstein anomaly
    • Pacemaker-induced valvular damage
  • Pericardial friction rub:
    • Pericarditis
    • Pericardial effusion
    • Postmyocardial infarction (Dressler syndrome)
    • Uremia
    • Radiation pericarditis
  • Ventricular septal defect:
    • Congenital
    • Traumatic
    • Postinfarction
    • Iatrogenic (postsurgical)
  • Ventricular assist device:
    • Implantable pump supplements or replaces ventricular function

Pediatric Considerations

  • 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

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