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The American Journal of Emergency... Nov 2021The purpose of this review is to draw attention to the presence and significance of murmurs other than the murmur of aortic regurgitation, in patients with aortic... (Review)
Review
The purpose of this review is to draw attention to the presence and significance of murmurs other than the murmur of aortic regurgitation, in patients with aortic dissection. For that purpose, a literature search was conducted using Pubmed and Googlescholar. The search terms were "dissecting aneurysm of the aorta", "systolic murmurs", "ejection systolic murmurs", "holosystolic" murmurs, "continuous murmurs", and "Austin-Flint" murmur. Murmurs other than the murmur of aortic regurgitation, which were associated with aortic dissection, fell into the categories of systolic murmurs, some of which were holosystolic, and continuous murmurs, the latter attributable to fistulae between the dissecting aneurysm and the left atrium, right atrium, and the pulmonary artery, respectively. Mid-diastolic murmurs were also identified, and these typically occurred in association with both the systolic and the early diastolic murmurs. Among patients with systolic murmurs clinical features which enhanced the pre-test probability of aortic dissection included back pain, stroke, paraplegia, unilateral absence of pulses, interarm differences in blood pressure, hypertension, shock, bicuspid aortic valve, aortic coarctation, Turner's syndrome, and high D-dimer levels, respectively. In the absence of the murmur of aortic regurgitation timely diagnosis of aortic dissection could be expedited by increased attention to parameters which enhance pretest probability of aortic dissection. That logic would apply even if the only murmurs which were elicited were systolic murmurs.
Topics: Aortic Dissection; Heart Auscultation; Heart Murmurs; Humans; Physical Examination
PubMed: 34102459
DOI: 10.1016/j.ajem.2021.05.041 -
American Family Physician Mar 2022Up to 8.6% of infants and 80% of children have a heart murmur during their early years of life. The presence of a murmur can indicate conditions ranging from no...
Up to 8.6% of infants and 80% of children have a heart murmur during their early years of life. The presence of a murmur can indicate conditions ranging from no discernable pathology to acquired or congenital heart disease. In infants with a murmur, physicians should review the obstetric and family histories to detect the possibility of congenital heart pathologies. Evaluation by a pediatric cardiologist is indicated for newborns with a murmur because studies show that neonatal murmurs have higher rates of pathology than in older children, and neonatal murmur characteristics are more difficult to evaluate during examination; referral is preferred over echocardiography. All infants, with or without a murmur, should have pulse oximetry screening to detect underlying critical congenital heart disease. In older children, most murmurs are innocent and can be followed with serial examinations if there are no findings of concern. Findings in older children that warrant referral include diastolic murmurs, loud or harsh-sounding murmurs, holosystolic murmurs, murmurs that radiate to the back or neck, or signs or symptoms of cardiac disease. Referral to a pediatric cardiologist is indicated when a pathologic murmur is suspected. Electrocardiography, chest radiography, and other tests should not be reflexively performed as part of all murmur evaluations because these tests can misclassify a murmur as innocent or pathologic, and they are not cost-effective. Emerging technologies include phonocardiography interpretation of murmurs and artificial intelligence algorithms for differentiating innocent from pathologic murmurs.
Topics: Artificial Intelligence; Child; Echocardiography; Electrocardiography; Heart Defects, Congenital; Heart Murmurs; Humans; Infant; Infant, Newborn
PubMed: 35289571
DOI: No ID Found -
The Thoracic and Cardiovascular Surgeon Aug 2018
Topics: Aortic Valve; Clinical Competence; Heart Auscultation; Heart Murmurs; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Predictive Value of Tests; Reproducibility of Results; Stethoscopes
PubMed: 30092601
DOI: 10.1055/s-0038-1667351 -
American Family Physician Oct 2011Heart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart... (Review)
Review
Heart murmurs are common in healthy infants, children, and adolescents. Although most are not pathologic, a murmur may be the sole manifestation of serious heart disease. Historical elements that suggest pathology include family history of sudden cardiac death or congenital heart disease, in utero exposure to certain medications or alcohol, maternal diabetes mellitus, history of rheumatic fever or Kawasaki disease, and certain genetic disorders. Physical examination should focus on vital signs; age-appropriate exercise capacity; respiratory or gastrointestinal manifestations of congestive heart failure; and a thorough cardiovascular examination, including features of the murmur, assessment of peripheral perfusion, and auscultation over the heart valves. Red flags that increase the likelihood of a pathologic murmur include a holosystolic or diastolic murmur, grade 3 or higher murmur, harsh quality, an abnormal S2, maximal murmur intensity at the upper left sternal border, a systolic click, or increased intensity when the patient stands. Electrocardiography and chest radiography rarely assist in the diagnosis. Referral to a pediatric cardiologist is recommended for patients with any other abnormal physical examination findings, a history of conditions that increase the likelihood of structural heart disease, symptoms suggesting underlying cardiac disease, or when a specific innocent murmur cannot be identified by the family physician. Echocardiography provides a definitive diagnosis and is recommended for evaluation of any potentially pathologic murmur, and for evaluation of neonatal heart murmurs because these are more likely to be manifestations of structural heart disease.
Topics: Adolescent; Child; Child, Preschool; Heart Auscultation; Heart Murmurs; Humans; Infant; Infant, Newborn; Physical Examination; Prevalence; Referral and Consultation
PubMed: 22010618
DOI: No ID Found -
Pediatric Clinics of North America Feb 2014The first-time appearance of a murmur in an adolescent can create a substantial amount of anxiety in the parents and the teenager. The appropriate evaluation and... (Review)
Review
The first-time appearance of a murmur in an adolescent can create a substantial amount of anxiety in the parents and the teenager. The appropriate evaluation and diagnosis is very important in decision-making regarding sports participation in this population. Accurate identification of the innocent murmurs can obviate the need for echocardiography. Identification of a pathologic murmur may reduce morbidity and, possibly, mortality in critical lesions such as hypertrophic cardiomyopathy. This article discusses the physiology and characteristics of different murmurs, and outlines an approach to cardiac murmurs in adolescents.
Topics: Adolescent; Heart; Heart Diseases; Heart Murmurs; Humans
PubMed: 24267454
DOI: 10.1016/j.pcl.2013.09.014 -
Heart Disease and Stroke : a Journal... 1993
Topics: Aortic Valve Insufficiency; Diastole; Heart Murmurs; Humans; Mitral Valve Stenosis; Pulmonary Valve Insufficiency
PubMed: 8149107
DOI: No ID Found -
The Medical Clinics of North America May 2022Patients with valvular heart disease may present with or without symptoms. A thorough cardiac physical examination can identify patients who require further evaluation... (Review)
Review
Patients with valvular heart disease may present with or without symptoms. A thorough cardiac physical examination can identify patients who require further evaluation and management. Although the utility of different cardiac findings varies widely, diastolic murmurs indicate important underlying valvular pathology requiring further investigation, typically with echocardiography. The proper examination of patients with systolic murmurs, the most common murmurs in clinical practice, is fundamental to cost-effective care. We will review the key components of the cardiac examination and findings relevant to functional murmurs, aortic stenosis, mitral valve prolapse and regurgitation, tricuspid regurgitation, hypertrophic cardiomyopathy, aortic regurgitation, and mitral stenosis.
Topics: Echocardiography; Heart Murmurs; Heart Valve Diseases; Humans; Physical Examination
PubMed: 35491074
DOI: 10.1016/j.mcna.2021.12.011 -
Pediatrics in Review Apr 2007
Review
Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Heart Auscultation; Heart Diseases; Heart Murmurs; Heart Sounds; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Medical History Taking
PubMed: 17400822
DOI: 10.1542/pir.28-4-e19 -
Circulation Apr 1958
Topics: Cardiovascular Abnormalities; Cardiovascular System; Heart Murmurs; Heart Sounds; Systolic Murmurs
PubMed: 13523772
DOI: 10.1161/01.cir.17.4.601 -
Lancet (London, England) Mar 1986
Topics: Acute Kidney Injury; Aortic Valve Insufficiency; Diastole; Heart Auscultation; Heart Murmurs; Humans
PubMed: 2869216
DOI: No ID Found