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Heart Murmur

by B. Mahato

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  • What is a murmur?
    • “swishing” sound produced by turbulent blood flow
  • How are murmurs characterized?
    • phase
      • systolic
      • diastolic
      • holosystolic: throughout systolic
        • aortic & pulmonic stenosis
        • mitral & tricuspid regurgitation
    • shape
      • early systolic
      • late systolic
    • quality
      • blowing
      • high pitch
      • low pitch
    • location
      • base
      • apex
    • intensity
      • I: very subtle
      • II: not obvious
      • III: readily auscultated
      • IV: thrill
      • V: no stethoscope needed to hear the murmur
      • VI: can be heard as the patent walks into the office
    • transformation
      • pressure change
      • volume loading change
  • What is the murmur due to mitral regurgitation (MR) like?
    • holosystolic
    • present at apex
    • radiates to the axilla and sometimes to the back
  • What are some of the possible causes of systolic murmur in a young person?
    • ASD: left to right flow –> more volume on right –> increased flow via pulmonic valve –> turbulent flow [Reynold’s number = (density x velocity x length)/viscosity]–> murmur.
    • VSD
    • ASD and VSD could be well compensated.
  • What is rheumatic heart disease (RHD),  and why is there a murmur heard in this disease?
    • pharyngitis (strep) –> antibodies to strep cross react leading to
      • polyarthritis
      • chorea
      • mitral stenosis
    • The murmur heard is from mitral stenosis. It is a late diastolic murmur heard during atrial kick. The antibodies cross react with mitral valve, leading to fibrotic changes and stenosis.
  • Why can a murmur be heard during pregnancy?
    • pregnancy –> increased flow volume –> turbulent flow across aortic valve –> murmur
Acknowledgment:
The above note is based, at least in part, on the discussion during a Harvard Medical School tutorial lead by Dr. Sonja K Rakowski, M.D. of Brigham and Women’s Hospital, Boston. Other participants included Annie Nguyen, Bisundev Mahato, Christine Linh-Minh Pham, Joshua Jeffrey Aaron Baugh, Kanika Bharti Sharma,  Lisa Y. Siu, Peter Kirkhoff Olds, and Samira Salari. Errors, if any, are my own.
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