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This topic is from Rosen and Barkin's 5-Minute Emergency Medicine Consult About our sources

Heart Murmur Reviewed 10/2010

Leon D. Sanchez, Francis J. O’Connell
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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

ONGOING CARE

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • Sounds created by physiologic processes or functional and structural anomalies of the heart.
  • Stenotic lesions:
    • Pressure overload in the chamber preceding the valve, leading to hypertrophy of the chamber in an attempt to overcome the increased resistance
  • Regurgitant lesions:
    • Volume overload of the chamber preceding the valve, leading to chamber dilatation in an attempt to accommodate the regurgitant blood volume.
  • Genetic abnormalities:
    • Congenital defects because of abnormal cardiac blood flow
Etiology
  • Aortic stenosis:
    • Rheumatic heart disease
    • Congenital bicuspid valve
    • Calcification of valve from aging
    • Prosthetic valve
  • Aortic regurgitation:
    • Rheumatic heart disease
    • Endocarditis
    • Aortic dissection
    • Prosthetic valve
  • Mitral stenosis:
    • Rheumatic heart disease
    • Rheumatologic disorders (systemic lupus erythematosus)
    • Calcification
    • Cardiac tumors (atrial myxoma)
    • Congenital
    • Prosthetic valve
  • Mitral regurgitation, acute:
    • Endocarditis ...

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Identifying Heart Murmurs Aortic Regurgitation Occurring when the leaflets of the aortic valve fail to close completely, the murmur of aortic regurgitation is the result of blood flowing from the aorta back into the left ventricle. This results in left ventricular volume overload. An ejection sound also may be present. Severe regurgitation should be suspected if an S3 or S4 is also present. The apical impulse becomes displaced downward and laterally with a widened diameter and increased duration. As the pulse pressure increases, the arterial pulses are often large and bounding. Location: Second to fourth left intercostal spaces Radiation: May radiate to the apex or left sternal border Intensity: Grade 1 to 3 Pitch: High Quality: Blowing, sometimes mistaken for breath sounds Position: Heard best with the patient sitting, leaning forward. Have the patient exhale and then hold his or her breath.Credit: From Weber J RN, EdD and Kelley J RN, PhD. Health Assessment in Nursing, 2nd edition. Philadelphia: Lippincott Williams & Wilkins, 2003.
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