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
References and Links
LITFL
Journal Articles and Textbooks
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines . Circulation. 2021 Feb 2;143(5):e72-e227.
Otto CM. Textbook of Clinical Echocardiography . Elsevier. 7e, 2023.
Houghton AR. Making Sense of Echocardiography: A Hands-on Guide . 3e 2023
CCC Differential Diagnosis Series
NEURO
Anosmia , Ataxia , Blepharospasm , Bulbar and Pseudobulbar palsy , Central Pontine Myelinosis , Cerebellar Disease , Chorea , Cranial nerve lesions , Dementia , Dystonia , Exophthalmos , Eye trauma , Facial twitches , Fixed dilated pupil , Horner syndrome , Loss of vision , Meningism , Movement disorders , Optic disc abnormality , Parkinsonism , Peripheral neuropathy , Radiculopathy , Red eye , Retinal Haemorrhage , Seizures , Sudden severe headache , Tremor , Tunnel vision
RESP
Bronchial breath sounds , Bronchiectasis , High airway pressures , Massive haemoptysis , Sore throat , Tracheal displacement
CVS
Atrial Fibrillation , Bradycardia , Cardiac Failure , Chest Pain , Murmurs , Post-resuscitation syndrome , Pulseless Electrical Activity (PEA) , Pulsus Paradoxus , Shock , Supraventricular tachycardia (SVT) , Tachycardia , VT and VF , SVC Obstruction
GIT
Abdominal distension , Abdominal mass , Abdominal pain , Asterixis , Dysphagia , Hepatomegaly , Hepatosplenomegaly , Large bowel obstruction , Liver palpation abnormalities , Lower GI haemorrhage , Malabsorption , Medical causes of abdominal pain , Rectal mass , Small bowel obstruction , Upper GI Haemorrhage
GUT
Genital ulcers , Groin lump , Scrotal mass , Urine colour , Urine Odour , Urine transparency ,
MSK
Arthritis , Shoulder pain , Wasting of the small muscles of the hand
DERM
Palmar erythema , Serious skin signs in sick patients , Thickened Tethered Skin , Leg ulcers , Skin Tumour , Acanthosis Nigricans
ENDO
Diabetes Insipidus , Diffuse Goitre , Gynaecomastia , Hirsutism , Hypoglycaemia , SIADH , Weight Loss
HAEM
Splenomegaly
PAEDS
Floppy infant
MISC
Anaphylaxis , Autoimmune associated diseases , Clubbing , Parotid Swelling , Splinter haemorrhages , Toxic agents and abnormal vitals , Toxicological causes of cardiac arrest
IMAGING
CHEST: Atelectasis , Hilar adenopathy , Hilar enlargement on CXR , Honeycomb lung , Increased interstitial markings , Mediastinal widening on mobile CXR , Pulmonary fibrosis , Pseudoinfiltrates on CXR , Pulmonary opacities on CXR ,Gas on abdominal X-ray , Kidney mass ,Intracranial calcification , Intracranial structures with contrast , Ventriculomegaly ,OTHER: Pseudofracture on X-Ray ,
LABS
LOW: Anaemia , Hypocalcaemia , hypochloraemia , Hypomagnesaemia ,
HIGH: Bilirubin and Jaundice , Hyperammonaemia , Hypercalcaemia , Hyperchloraemia , Hyperkalaemia , Hypermagnesaemia ,
ACID BASE: Acid base disorders , Resp. acidosis , Resp. alkalosis ,
Creatinine , CRP , Dipstick Urinalysis , Laboratory Urinalysis , Liver function tests (LFTs) , Pleural fluid analysis , Urea , Urea Creatinine Ratio , Uric acid , Urinalysis , Urine Electrolytes
