Heart murmur resident survival guide

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

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• papillary muscle rupture complicating acute myocardial infarction (MI)
• rupture of chordae tendineae.
• infective endocarditis
• blunt chest wall trauma

Common Causes

• systolic murmur
  • Ejection murmurs
    • Functional
      • Still's murmur and its adult variant
      • Flow murmur emanating from the root of the pulmonary artery
      • Murmur associated with high cardiac output states
      • Flow murmurs associated with aortic or pulmonary valvular insufficiency
    • Organic
      • Valvular aortic stenosis
      • Aortic sclerosis
      • Discrete subvalvular aortic stenosis (web or tunnel)
      • Supravalvular aortic stenosis
      • Hypertrophic obstructive cardiomyopathy
      • Pulmonary valvular stenosis
      • Pulmonary infundibular stenosis
      • Atrial septal defect
      • Tetralogy of Fallot
  • Regurgitant murmurs
    • Functional: none
    • Organic:
      • Mitral regurgitation:
        • Rheumatic
        • Papillary muscle dysfunction
        • Mitral valve prolapse
        • Acute
      • Tricuspid regurgitation:
        • Chronic
        • Acute
      • Ventricular septal defect
        • Roger's type (small and large)
          • Without pulmonary hypertension
          • With pulmonary hypertension
        • Slitlike
    • Extracardiac sounds simulating systolic heart murmurs
      • Subclavian (supraclavicular/brachiocephalic) murmur
      • Internal mammary soufflé
      • Carotid artery bruits
      • Coarctation of the aorta
      • Murmurs emanating from a dilated aortic or pulmonary artery root
      • Patent ductus arteriosus with pulmonary hypertension
        
• diastolic murmur
  • Aortic regurgitation
  • Pulmonary valve regurgitation
  • Mitral rumble
    • Obstruction to flow
      • Mitral stenosis (rheumatic, congenital)
      • Left atrial myxoma
      • Cor triatriatum
      • Localized pericardial constriction
    • Increased flow
      • Mitral regurgitation
      • Ventricular septal defect
      • Patent ductus arteriousus
      • Complete heart block
  • Tricuspid rumble
    • Obstruction to flow
      • Tricuspid stenosis (rheumatic, Ebstein's anomoly, carinoid)
      • Right atrial myxoma
      • Localized pericardial constriction
    • Increased flow
      • Atrial septal defect
      • Tricuspid regurgitation
• continuous murmur
  • THORACIC:
    • Precordial
      • Patent ductus arteriosus
      • Coronary arteriovenous fistulas
      • Sinus of Valsalva aneurysm ruptured into right cavities
      • Atrial septal defect associated with abnormalities that cause increased pressure in the left atrium
      • Left coronary artery origin from pulmonary artery anomaly
      • Continuous murmur at intern mammary artery
    • Extra Precordial
      • Coarctation of the aorta
      • Pulmonary atresia
      • Pulmonary arteriovenous fistula
      • Truncus arteriosus
      • Anomalies of origin of the pulmonary artery
  • EXTRATHORACIC:
    • Venous hum
    • Cruveilhier-Baumgarten sindrom
    • Sever arterial stenosis
    • Extrathoracic arteriovenos fistulas

Diagnosis

Shown below is an algorithm summarizing the Strategy for evaluating heart murmurs according the the ACC/AHA Guidelines for the Management of Patients With ValvularHeart Disease.

Cardiac murmur

systolic murmur

diastolic murmur

continuous murmur

❑ Midsystolic, grade 2 or less

❑Early systolic, ❑ Midsystoilic grade 3 or more, ❑ Late systolic, ❑ Holosystolic murmur

Echocardiography

❑ Venous hum, ❑ Mammary souffle of pregnancy

Asymptomatic and no associated findings

❑ Symptomatic or other signs of cardiac diseases, ❑ If an ECG or X-ray has been obtained and is abnormal

catheterization and angiography if appropriate

No further workup

No further workup

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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