heart murmur
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Classification
- grade 1: faint murmur, heard with difficulty
- grade 2: faint murmer, easily identified
- grade 3: moderately loud murmur
- grade 4: loud murmur associated with palpable thrill
- grade 5: very loud murmur, cannot be heard without stethocope
- grade 6: loudest murmurs, can be heard without stethocope[3]
Etiology
Clinical manifestations
- systolic murmurs
- graded I to VI
- differential response to maneuvers (see systolic murmur)
- holosystolic murmur engulfs heart sounds S1 & S2
- Diastolic murmurs:
- graded I to IV
- early diastolic murmur
- begin immediately following S2
- high-pitched
- aortic regurgitation
- pulmonic regurgitation
- mid-to-late diastolic murmur
- low-pitched
- heard best with bell of stethoscope
- Continuous murmur
- innocent murmurs:
- patient is asymptomatic
- typically midsystolic, located at base of heart, grade 1-2/6 without radiation, normal splitting of S2, soft S3 may be present[3]
- heart murmurs of pregnancy
- may mimic valvular heart disease
- increased P2, S3
- early peaking systolic murmur over the left sternal border
- S4 >= 3/6 in intensity, fixed S2, diastolic murmur, continuous murmur are signs of serious cardiac disease
- right-sided murmur increases with inspiration
Diagnostic procedures
- transthoracic echocardiogram
- indications:
- systolic murmur grade 3/6 or greater
- late or holosystolic murmurs
- diastolic murmur
- continuous murmur
- murmur with accompanying symptoms[3]
- contraindications: innocent murmurs
- indications:
- transesophageal echocardiogram
- improved imaging quality, especially for mitral valve
More general terms
More specific terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 327-28
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 199
- ↑ 3.0 3.1 3.2 3.3 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 17, 18. American College of Physicians, Philadelphia 2006, 2012, 2015, 2018.
- ↑ Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA. 1997 Feb 19;277(7):564-71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9032164
- ↑ Premkumar P. Utility of Echocardiogram in the Evaluation of Heart Murmurs. Med Clin North Am. 2016 Sep;100(5):991-1001. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27542419
- ↑ What Is a Heart Murmur? http://www.nhlbi.nih.gov/health/dci/Diseases/heartmurmur/hmurmur_what.html