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__NOTOC__
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{{Continuous murmur}}
{{SI}}
{{CMG}}; {{AE}} {{TS}}
{{CMG}}; {{AE}} {{TS}}


==Overview==
==Overview==
A continuous murmur begins in [[systole]] and continues into [[diastole]].  They are caused by blood flow from high pressure chambers into low pressure chambers.  The most common causes of continuous murmurs are [[patent ductus arteriosus]], [[arteriovenous fistula]] and arterial [[stenosis]].


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
 
*[[Abdominal aortic aneurysm]]
 
*[[Pulmonary embolism]]<ref name="pmid975962">{{cite journal| author=ZuWallack RL, Liss JP, Lahiri B| title=Acquired continuous murmur associated with acute pulmonary thromboembolism. | journal=Chest | year= 1976 | volume= 70 | issue= 4 | pages= 557-9 | pmid=975962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=975962  }} </ref>
 
===Common Causes===
===Common Causes===
 
*[[Anemia]]
*[[Aortic coarctation]]
*[[Arteriovenous fistula]]
*[[Venous hum|Cervical venous hum]]
*[[Patent ductus arteriosus]]
*[[Pericardial friction rub]]
*[[Pregnancy]]
*[[Pulmonary arteriovenous fistula]]
*[[Renal artery stenosis]]
*[[Valvular heart disease ]]


===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atherosclerosis]],  [[endocarditis]], [[Abdominal aortic aneurysm surgery#Complications|perianeurysmal aortitis]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Abdominal aortic aneurysm]], [[anemia]], [[aortic coarctation]], [[Fistula|aortic-atrial fistulas]],<ref name="pmid16412186">{{cite journal| author=Jassal DS, Neilan TG, Hung J| title=A continuous murmur. | journal=Echocardiography | year= 2006 | volume= 23 | issue= 1 | pages= 60-1 | pmid=16412186 | doi=10.1111/j.1540-8175.2005.00112.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16412186 }} </ref> [[arteriovenous fistula]], [[arteriovenous malformation]], [[atrial septal defect]] with [[mitral stenosis]], [[carotid artery stenosis]], [[celiac artery]] stenosis, [[Venous hum|cervical venous hum]], [[coronary artery fistula ]], [[Cruveilhier-Baumgarten murmur|hepatic hum]], [[Lutembacher's syndrome]], [[mammary souffle]], [[mitral stenosis]] with [[SVC|a persistent left superior vena cava]], [[patent ductus arteriosus]], [[pericardial friction rub]], [[pulmonary atresia]] with [[ventricular septal defect]], [[renal artery stenosis]], [[Aneurysm of sinus of valsalva complications|ruptured aneurysm of sinus of valsalva]], [[takayasu arteritis]], [[total anomalous pulmonary venous drainage]], [[tricuspid atresia]], [[tricuspid regurgitation]], [[truncus arteriosus]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| [[Acute febrile neutrophilic dermatosis]],  [[psoriasis]]
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Furosemide]]
|bgcolor="Beige"|No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hyperthyroidism]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Crohn's disease]],  [[ulcerative colitis]]
|bgcolor="Beige"| [[Cirrhosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[Interleukin 23|IL-23 overexpression]],  [[Wiskott-Aldrich syndrome]]
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| [[Myelodysplastic syndrome]]
|bgcolor="Beige"|[[Anemia]], [[hepatic hemangioma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic''
|bgcolor="Beige"| [[Cardiac catheterization]], [[Abdominal aortic aneurysm surgery#Complications|perianeurysmal aortitis]]
|bgcolor="Beige"|[[Arteriovenous fistula]], [[cimino fistula]], [[Fistula|fistula between an internal mammary graft and the pulmonary vasculature]]<ref name="pmid15301909">{{cite journal| author=Guray U, Guray Y, Ozbakir C, Yilmaz MB, Sasmaz H, Korkmaz S| title=Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur. | journal=Int J Cardiol | year= 2004 | volume= 96 | issue= 3 | pages= 489-92 | pmid=15301909 | doi=10.1016/j.ijcard.2003.05.035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15301909 }} </ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[AIDS natural history, complications, and prognosis#Other complications|AIDS]],  [[aspergillus]],  [[bacteremia]],  [[borrelia burgdorferi]],  [[candida]],  [[endocarditis]],  [[enterococcus]],  [[escherichia coli]],  [[Fusarium solani f.sp. pisi|fusarium solani]],  [[gonorrhea]],  [[haemophilus influenzae]],  [[hepatitis B]],  [[hepatitis C]],  [[mycobacterium fortuitum]],  [[mycobacterium tuberculosis]],  [[mycotic aneurysm]],  [[pasteurella multocida]],  [[proteus]],  [[pseudomonas]],  [[Reiter's syndrome]],  [[rocky mountain spotted fever]],  [[Salmonella#Salmonella- associated diseases|salmonella]],  [[staphylococcus]],  [[streptococcus pneumoniae]],  [[Syphilis history and symptoms#Tertiary syphilis|syphilis]],  [[yaws]]
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Anemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Mammary souffle]], [[pregnancy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Cholangiocarcinoma]], [[hemangioma|hepatic hemangioma]], [[hepatoma]], [[metastasis|liver metastases]], [[renal cell carcinoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Pulmonary arteriovenous fistula]], [[pulmonary artery stenosis]], [[pulmonary atresia]] with [[ventricular septal defect]], [[pulmonary embolism]]<ref name="pmid975962">{{cite journal| author=ZuWallack RL, Liss JP, Lahiri B| title=Acquired continuous murmur associated with acute pulmonary thromboembolism. | journal=Chest | year= 1976 | volume= 70 | issue= 4 | pages= 557-9 | pmid=975962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=975962  }} </ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Renal artery stenosis]], [[renal cell carcinoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Acute febrile neutrophilic dermatosis]],  [[ANCA-associated vasculitides]],  [[Ankylosing spondylitis natural history, complications and prognosis#Complications|ankylosing spondylitis]],  [[Autoimmune Vasculitis|autoimmune vasculitis]],  [[Behçet's disease]],  [[capnocytophaga canimorsus]],  [[Churg-Strauss syndrome]],  [[Cogan syndrome]],  [[Temporal arteritis natural history, complications and prognosis#Complications|giant cell arteritis]],  [[IgG4-related systemic disease]],  [[juvenile rheumatoid arthritis]],  [[Kawasaki disease]],  [[microscopic polyangiitis]],  [[Ormond's disease]],  [[polyarteritis nodosa]],  [[psoriasis]],  [[reactive arthritis]],  [[Reiter's syndrome]],  [[relapsing polychondritis]],  [[retroperitoneal fibrosis]],  [[rheumatoid arthritis]],  [[scleroderma]],  [[spondylarthropathy]],  [[systemic lupus erythematosus]],  [[Takayasu arteritis#Natural History, Complications and Prognosis|Takayasu arteritis]],  [[Wegener granulomatosis]]
|bgcolor="Beige"|[[Paget's disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Arteriovenous fistula]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Retroperitoneal fibrosis|Idiopathic isolated periaortitis]],  [[Idiopathic|idiopathic isolated aortitis]],  [[sarcoidosis]]
|bgcolor="Beige"| No underlying causes
|-
|-
|}
|}
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*[[Abdominal aortic aneurysm]]
*[[Abdominal aortic aneurysm]]
*[[Anemia]]
*[[Anemia]]
*[[Coronary artery fistula|Anomalous left coronary artery arising from pulmonary artery]]
*[[Aortic coarctation]]
*[[Aortic-atrial fistulas]]
*[[Fistula|Aortic-atrial fistulas]]<ref name="pmid16412186">{{cite journal| author=Jassal DS, Neilan TG, Hung J| title=A continuous murmur. | journal=Echocardiography | year= 2006 | volume= 23 | issue= 1 | pages= 60-1 | pmid=16412186 | doi=10.1111/j.1540-8175.2005.00112.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16412186  }} </ref>
*[[Arteriovenous fistula]]
*[[Arteriovenous fistula]]
*[[Arteriovenous malformation]]
*[[Arteriovenous malformation]]
*[[Lutembacher's syndrome|Atrial septal defect with mitral stenosis or atresia]]
*[[Atrial septal defect]] with [[mitral stenosis]]
*[[Atrial septal defect]] without [[mitral valve]] obstruction
*[[Carotid artery stenosis]]
*[[Bronchial arterial collateral vessels develop in pulmonary atresia with ventricular septal defect]]
*[[Celiac artery| Celiac artery stenosis]]
*[[Bronchial arterial collateral vessels develop in tricuspid atresia ]]
*[[Celiac artery stenosis]]
*[[Venous hum|Cervical venous hum]]
*[[Venous hum|Cervical venous hum]]
*[[Cholangiocarcinoma]]
*[[Cholangiocarcinoma]]<ref name="pmid222133">{{cite journal| author=Motoki T, Hayashi T, Katoh Y, Sakamoto T, Takeda T, Murao S| title=Hepatic bruits in malignant liver tumors. | journal=Am J Gastroenterol | year= 1979 | volume= 71 | issue= 6 | pages= 582-6 | pmid=222133 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=222133  }} </ref>
*[[Cirrhosis]]
*[[Cimino fistula]]
{{col-break|width=33%}}
*[[Cirrhosis]]<ref name="pmid13230354">{{cite journal| author=MACPHERSON AI, MORTON EV| title=Continuous venous hum in a case of portal cirrhosis. | journal=Br Heart J | year= 1955 | volume= 17 | issue= 1 | pages= 105-8 | pmid=13230354 | doi= | pmc=PMC503892 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13230354  }} </ref>
*[[Coronary artery fistula]]
{{col-break|width=33%}}
{{col-break|width=33%}}
*[[Coronary artery fistula|Communication between the sinus of valsalva and the right atrium]]
*[[Fistula|Fistula between an internal mammary graft and the pulmonary vasculature]]<ref name="pmid15301909">{{cite journal| author=Guray U, Guray Y, Ozbakir C, Yilmaz MB, Sasmaz H, Korkmaz S| title=Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur. | journal=Int J Cardiol | year= 2004 | volume= 96 | issue= 3 | pages= 489-92 | pmid=15301909 | doi=10.1016/j.ijcard.2003.05.035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15301909 }} </ref>
*[[Coronary artery fistula]]
*[[Hemangioma|Hepatic hemangioma]]
*[[Coronary artery fistula|Fistula between right coronary artery and coronary sinus ]]
*[[Coronary artery fistula|Fistula between right coronary artery and right atrium ]]
*[[Fistulous connection between an internal mammary graft and the pulmonary vasculature]]<ref name="pmid15301909">{{cite journal| author=Guray U, Guray Y, Ozbakir C, Yilmaz MB, Sasmaz H, Korkmaz S| title=Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur. | journal=Int J Cardiol | year= 2004 | volume= 96 | issue= 3 | pages= 489-92 | pmid=15301909 | doi=10.1016/j.ijcard.2003.05.035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15301909 }} </ref>
*Hepatic [[hemangioma]]
*[[Cruveilhier-Baumgarten murmur|Hepatic hum]]
*[[Cruveilhier-Baumgarten murmur|Hepatic hum]]
*[[Aortic coarctation|High-grade coarctation]]
*[[Hepatoma]]
*[[Hyperthyroidism]]
*[[Hyperthyroidism]]
*[[Cimino fistula|Large dialysis fistula]]
*[[Metastasis|Liver metastasis]]<ref name="pmid222133">{{cite journal| author=Motoki T, Hayashi T, Katoh Y, Sakamoto T, Takeda T, Murao S| title=Hepatic bruits in malignant liver tumors. | journal=Am J Gastroenterol | year= 1979 | volume= 71 | issue= 6 | pages= 582-6 | pmid=222133 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=222133  }} </ref>
*Liver[[metastases]]
*[[Lutembacher's syndrome]]
*[[Lutembacher syndrome]]
*[[Mammary souffle]]
*[[Mammary souffle]]
*[[Mitral stenosis]] with a persistent left [[superior vena cava]]
*[[Mitral stenosis]] [[SVC|with a persistent left superior vena cava]]
*Partial occlusion of the pulmonary artery due to [[pulmonary embolism]]
*[[Paget's disease]]
*[[Pulmonary embolism]]<ref name="pmid975962">{{cite journal| author=ZuWallack RL, Liss JP, Lahiri B| title=Acquired continuous murmur associated with acute pulmonary thromboembolism. | journal=Chest | year= 1976 | volume= 70 | issue= 4 | pages= 557-9 | pmid=975962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=975962  }} </ref>
*[[Patent ductus arteriosus]]
*[[Patent ductus arteriosus]]
*[[Pericardial friction rub]]
{{col-break|width=33%}}
*[[Pregnancy]]
*[[Pregnancy]]
*[[Pulmonary arteriovenous fistula]]
*[[Pulmonary arteriovenous fistula]]
*[[Pulmonary artery stenosis]]
*[[Pulmonary artery stenosis]]
*[[Pulmonary atresia]] with [[ventricular septal defect]]
*[[Renal artery stenosis]]
*[[Renal artery stenosis]]
*[[Ruptured aneurysm of sinus of valsalva]]
*[[Renal cell carcinoma]]
*[[Systemic arteriovenous fistulas]]
*[[Aneurysm of sinus of valsalva complications|Ruptured aneurysm of sinus of valsalva]]
*[[Takayasu arteritis]]
*[[Takayasu arteritis]]
*[[Total anomalous pulmonary venous drainage]]
*[[Total anomalous pulmonary venous drainage]]
*[[Tricuspid atresia]]
*[[Tricuspid regurgitation]]
*[[Tricuspid regurgitation]]
*[[Truncus arteriosus]]
*[[Truncus arteriosus]]
*Turbulence of [[splenic artery]]
*[[Valvular heart disease ]]
*[[Valvular heart disease ]]
{{col-end}}
{{col-end}}

Latest revision as of 22:09, 25 November 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]

Overview

A continuous murmur begins in systole and continues into diastole. They are caused by blood flow from high pressure chambers into low pressure chambers. The most common causes of continuous murmurs are patent ductus arteriosus, arteriovenous fistula and arterial stenosis.

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

Causes by Organ System

Cardiovascular Abdominal aortic aneurysm, anemia, aortic coarctation, aortic-atrial fistulas,[2] arteriovenous fistula, arteriovenous malformation, atrial septal defect with mitral stenosis, carotid artery stenosis, celiac artery stenosis, cervical venous hum, coronary artery fistula , hepatic hum, Lutembacher's syndrome, mammary souffle, mitral stenosis with a persistent left superior vena cava, patent ductus arteriosus, pericardial friction rub, pulmonary atresia with ventricular septal defect, renal artery stenosis, ruptured aneurysm of sinus of valsalva, takayasu arteritis, total anomalous pulmonary venous drainage, tricuspid atresia, tricuspid regurgitation, truncus arteriosus
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine Hyperthyroidism
Environmental No underlying causes
Gastroenterologic Cirrhosis
Genetic No underlying causes
Hematologic Anemia, hepatic hemangioma
'Iatrogenic Arteriovenous fistula, cimino fistula, fistula between an internal mammary graft and the pulmonary vasculature[3]
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Anemia
Obstetric/Gynecologic Mammary souffle, pregnancy
Oncologic Cholangiocarcinoma, hepatic hemangioma, hepatoma, liver metastases, renal cell carcinoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Pulmonary arteriovenous fistula, pulmonary artery stenosis, pulmonary atresia with ventricular septal defect, pulmonary embolism[1]
Renal/Electrolyte Renal artery stenosis, renal cell carcinoma
Rheumatology/Immunology/Allergy Paget's disease
Sexual No underlying causes
Trauma Arteriovenous fistula
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. ↑ 1.0 1.1 1.2 ZuWallack RL, Liss JP, Lahiri B (1976). "Acquired continuous murmur associated with acute pulmonary thromboembolism". Chest. 70 (4): 557–9. PMID 975962.
  2. ↑ 2.0 2.1 Jassal DS, Neilan TG, Hung J (2006). "A continuous murmur". Echocardiography. 23 (1): 60–1. doi:10.1111/j.1540-8175.2005.00112.x. PMID 16412186.
  3. ↑ 3.0 3.1 Guray U, Guray Y, Ozbakir C, Yilmaz MB, Sasmaz H, Korkmaz S (2004). "Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur". Int J Cardiol. 96 (3): 489–92. doi:10.1016/j.ijcard.2003.05.035. PMID 15301909.
  4. ↑ 4.0 4.1 Motoki T, Hayashi T, Katoh Y, Sakamoto T, Takeda T, Murao S (1979). "Hepatic bruits in malignant liver tumors". Am J Gastroenterol. 71 (6): 582–6. PMID 222133.
  5. ↑ MACPHERSON AI, MORTON EV (1955). "Continuous venous hum in a case of portal cirrhosis". Br Heart J. 17 (1): 105–8. PMC 503892. PMID 13230354.
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