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Heart Murmur

Heart Murmur is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Sounds created by physiologic processes or functional and structural anomalies of the heart.
  • 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

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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Citation

Rosen, Peter, et al., editors. "Heart Murmur." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307591/all/Heart_Murmur.
Heart Murmur. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307591/all/Heart_Murmur. Accessed April 24, 2019.
Heart Murmur. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307591/all/Heart_Murmur
Heart Murmur [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307591/all/Heart_Murmur.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Heart Murmur ID - 307591 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307591/all/Heart_Murmur PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -