Continuous murmur

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

Overview

Continuous murmurs begin in systole and continue into diastole through the second heart sound. They are caused by blood flow from high pressure chamber to low pressure chamber. 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
Drug Side Effect
Ear Nose Throat	No underlying causes
Endocrine	hyperthyroidism
Environmental	No underlying causes
Gastroenterologic	cirrhosis
Genetic
Hematologic	anemia, hepatic hemangioma
'Iatrogenic	arteriovenous fistula, cimino fistula, fistulous connection between an internal mammary graft and the pulmonary vasculature^[3]
Infectious Disease
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

Causes in Alphabetical Order

Fistulous connection between an internal mammary graft and the pulmonary vasculature^[3]
Hepatic hemangioma
Hepatic hum
Hepatoma
Hyperthyroidism
Liver metastases^[4]
Lutembacher's syndrome
Mammary souffle
Mitral stenosis with a persistent left superior vena cava
Paget's disease
Pulmonary embolism^[1]
Patent ductus arteriosus
Pericardial friction rub

References

↑ ^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.
↑ ^2.0 ^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.
↑ ^3.0 ^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.
↑ ^4.0 ^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.
↑ 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.CS1 maint: PMC format (link)

[pmid975962-1] 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.

[pmid16412186-2] 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.

[pmid15301909-3] 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.

[pmid222133-4] 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.

[pmid13230354-5] 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.CS1 maint: PMC format (link)

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