Overview
A heart murmur is an audible sound produced by turbulent blood flow within the cardiovascular system.
Murmurs may be innocent or may reflect structural valve, myocardial, or congenital heart disease.
Characterization
Describe the timing, intensity, pitch, site of maximal auscultation, radiation, and effect of position or maneuvers.
Systolic murmurs are further differentiated into ejection and pansystolic patterns, while diastolic murmurs are generally considered pathological until proven otherwise.
Innocent vs Pathological
Features favoring an innocent murmur include a soft intensity, limited radiation, normal heart sounds, and absence of symptoms or other abnormal examination findings.
Symptoms, abnormal pulses, cyanosis, a harsh murmur, a thrill, or a diastolic component increase concern for structural disease.
A diastolic murmur warrants investigation because it is rarely physiological.
Investigation
ECG and echocardiography may be required when the murmur is suspicious or associated with symptoms or abnormal findings.
Echocardiography provides direct assessment of valve structure, chamber size, flow, and cardiac function.
Clinical Pearls
Always identify the timing of the murmur before trying to determine its cause.
END OF REVIEW
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