Heart Murmurs Overview

Following information from Life in the Fast Lane (LITFL):

Overview

  • Heart murmurs are abnormal heart sounds believed to be caused by turbulent flow across heart valves or vascular abnormalities.
  • When assessing a murmur, determine 6 characteristics: position at which it is loudest, grade, timing, duration, presence of a thrill, radiation and changes during respiration or with dynamic manoeuvers.

Causes

Continuous murmur

  • Patent ductus arteriosus
  • Arteriovenous fistula (coronary artery, pulmonary, systemic)
  • Aortopulmonary connection (e.g. congenital, Blalock shunt)
  • Venous hum (usually best heard over right supraclavicular fossa and abolished by ipsilateral internal jugular vein compression)
  • Rupture of sinus of Valsalva into right ventricle or atrium
  • ‘Mammary souffle’ (in late pregnancy or early postpartum period)

Mid-systolic murmur

  • Aortic stenosis
  • Pulmonary stenosis
  • Hypertrophic cardiomyopathy
  • Pulmonary flow murmur of an atrial septal defect

Pansystolic murmur

  • Mitral regurgitation
  • Tricuspid regurgitation
  • Ventricular septal defect
  • Aortopulmonary shunts

Early diastolic murmur

  • Aortic regurgitation
  • Pulmonary regurgitation

Mid-diastolic murmur

  • Mitral stenosis
  • Tricuspid stenosis
  • Atrial myxoma
  • Austin Flint murmur of aortic regurgitation
  • Carey Coombs murmur of acute rheumatic fever

Presystolic murmur

  • Mitral stenosis
  • Tricuspid stenosis
  • Atrial myxoma
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