Materiały źródłowe

• #1 Heart Murmur: Causes, Symptoms, Treatment

  https://my.clevelandclinic.org/health/diseases/17083-heart-murmur

  A heart murmur is a whooshing or swishing sound heard through a stethoscope when blood flows abnormally over your heart valves. […] However, murmurs should be evaluated because they may signal a heart problem or other health issue. […] A murmur may mean there’s a problem with your heart. But heart murmurs are also present in healthy people who don’t have a heart problem (called innocent heart murmurs). […] Diastolic and continuous murmurs are more likely related to heart disease. But every heart murmur should be evaluated. […] A healthcare provider can diagnose a heart murmur by listening to your heart. A murmur makes an abnormal swishing sound. […] If a healthcare provider hears a murmur, you may need further testing to rule out a health problem. […] Tests that can determine the cause of a heart murmur are:

• #1 Auscultation of cardiac murmurs in adults – UpToDate

  https://www.uptodate.com/contents/auscultation-of-cardiac-murmurs-in-adults

  Auscultation of cardiac murmurs in adults […] Cardiac auscultation is one of the most useful bedside diagnostic tools that a clinician can use to detect alterations in cardiovascular anatomy and physiology. Significant valvular heart disease is often first diagnosed based upon the finding of a murmur. Auscultation has a reported sensitivity of 70 percent and a specificity of 98 percent for the detection of valvular heart disease. […] This topic will review the auscultation of cardiac murmurs in adults, including the maneuvers (eg, respiration, Valsalva maneuver) that can be used to differentiate one murmur from another. […] Cardiac murmurs are the direct result of blood flow turbulence. The amount of turbulence and consequently the intensity of a cardiac murmur depend on the size of the orifice or vessel through which the blood flows; the pressure difference or gradient across the narrowing; and the blood flow or volume across the site.

• #1 Physiology, Cardiovascular Murmurs – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525958/

  Cardiac auscultation is an essential physical exam tool for providers. Comprehension of anatomy, physiology, and underlying physics, with mastery of physical examination, can uncover many potential pathologies and prevent serious complications. In trained individuals, sensitivity and specificity for murmurs can reach 70% and 98%, respectively. Since early detection of cardiac murmurs can be essential to reducing morbidity and mortality, healthcare providers should master these murmurs and their common etiologies. […] Murmurs are identifiable through auscultation using a manual or electronically enhanced stethoscope. Description of murmurs is made using the following criteria, explained below: location, quality, and timing. […] Most murmurs will increase or decrease in volume when the patient performs certain maneuvers. This dynamic quality of murmurs is used as a clinical tool during the patient’s physical exam to aid in diagnosing a specific murmur.

• #1 Checking for heart murmurs – Harvard Health

  https://www.health.harvard.edu/heart-health/checking-for-heart-murmurs

  A heart murmur is the sound of turbulent blood flow within the heart as heard through a stethoscope. […] Doctors classify heart murmurs into two main categories: benign (also called innocent or functional murmurs) and abnormal (also called structural or pathologic murmurs). […] When evaluating a heart murmur, a doctor will listen to your heart from different locations on your chest and back and may ask you do things that create subtle, temporary changes in blood flow through your heart, such as inhaling, gripping your hands, sitting, squatting, standing up quickly, or lying down. […] If a murmur is detected, you’ll need additional tests to determine the cause. These can include an echocardiogram (ultrasound of the heart), an electrocardiogram (which records the heart’s electrical activity), and a chest x-ray.

• #1 Heart Murmurs | American Heart Association

  https://www.heart.org/en/health-topics/heart-murmurs

  Your child’s doctor listens to their heart with a stethoscope to detect heart murmurs. […] If your child’s doctor hears a murmur when listening to their heart, they may recommend additional testing, such as an electrocardiogram (ECG) or echocardiogram (echo). This is to confirm the murmur is innocent. Unless testing suggests otherwise, no additional steps may be needed. […] Non-innocent (or abnormal) heart murmurs are often caused by defective heart valves. […] Certain congenital defects and other conditions such as pregnancy, fever, anemia or thyrotoxicosis (a condition caused by an overactive thyroid gland) can also cause murmurs. […] A murmur that occurs when the heart muscle relaxes between beats is called a diastolic murmur. A systolic murmur occurs when the heart muscle contracts. […] Systolic murmurs are graded by intensity (loudness) from 1 to 6. A grade 1 is faint, heard only with a special effort. It’s softer than the normal heart sounds. A grade 6 is extremely loud, and can be heard with no contact between stethoscope and the chest.

• #1 Heart murmurs: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003266.htm

  When a murmur is more noticeable, the provider may be able to feel it with the palm of the hand over the heart. This is called a „thrill” and means the murmur is grade 4 or higher. […] Things the provider will look for in the exam include: […] The following tests may be done: […] Chest x-ray […] Electrocardiogram (ECG) […] Echocardiography.

• #1 Heart murmurs – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-murmurs/diagnosis-treatment/drc-20373175

  Heart murmurs may be detected when a physical exam is done for another reason. You’ll be asked questions about your personal and family medical history. […] A health care provider can listen to the heart using a device called a stethoscope. The provider considers several things when listening to the heart to tell if a murmur is innocent or worrisome. Some of those things are: […] Tests are done to determine the cause of worrisome heart murmurs. Heart murmur tests may include: […] Echocardiogram. This is the main test used to determine the cause of a heart murmur. An echocardiogram uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and heart valves. […] Chest X-ray. A chest X-ray is a picture of the heart and lungs. It can tell whether the heart is enlarged. Heart enlargement may cause some heart murmurs.

• #1 Heart Murmur – Harvard Health

  https://www.health.harvard.edu/a_to_z/heart-murmur-a-to-z

  Echocardiography This noninvasive test uses sound waves to create an image of the heart’s structure, including the structure of its valves. […] Doppler echocardiography This test is similar to echocardiography, but it creates an image of the heart’s blood flow patterns rather than its structure. […] Cardiac catheterization In this test, a small, sterile tube called a catheter is guided into the heart to measure pressures and oxygen levels in the heart’s chambers. […] Blood tests Blood tests are used to check for infection in people with suspected endocarditis or pericarditis.

• #1 Heart murmurs – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heart-murmurs/diagnosis-treatment/drc-20373175

  Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. […] Cardiac catheterization. This test may be done when other tests haven’t found a cause for the heart murmur. […] Treatment for a worrisome heart murmur depends on cause. A worrisome heart murmur requires close monitoring by a health care provider. Medications or surgery may be needed. […] Surgery may be needed to correct a condition that causes a worrisome heart murmur. […] If a narrowed or leaky heart valve is causing the murmur and other symptoms, heart valve repair or replacement may be needed. […] If you’re concerned about a heart murmur, make an appointment to see your family care provider. Although most heart murmurs are harmless, it’s a good idea to check for any underlying heart problems that could be serious.

• #1 Evaluation and Management of Heart Murmurs in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1001/p793.html

  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. […] Chest radiography and ECG rarely assist in the diagnosis of a heart murmur. […] A prospective study of 201 newborns who were referred to pediatric cardiologists for evaluation of a heart murmur found that the addition of ECG to clinical assessment did not improve the sensitivity or specificity of detecting structural heart lesions. […] In a study of 128 infants and children who were evaluated for heart murmurs, the addition of ECG and chest radiography to cardiac auscultation was more likely to mislead than assist the physician in making the correct diagnosis.

• #1 Heart Murmurs Topic Review | Learn the Heart

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/heart-murmurs

  Describing Murmurs|Systolic Murmurs|Diastolic Murmurs|Dynamic Auscultation […] Disease of the cardiac valves and other cardiac structures frequently results in abnormal, turbulent blood flow within the heart, causing murmurs. […] Careful auscultation of heart murmurs is an extremely valuable tool in the diagnosis of many cardiac conditions. […] Murmurs are described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation and response to dynamic maneuvers. Using the above, clinicians can accurately characterize the nature of a murmur and communicate their findings in a precise manner. […] The timing of a murmur is crucial to accurate diagnosis. A murmur is either systolic, diastolic or continuous throughout systole and diastole. […] With the knowledge of the possible cardiovascular conditions that cause systolic or diastolic murmurs, the clinician can narrow their differential diagnosis.

• #1 Heart murmurs: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003266.htm

  A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by turbulent (rough) blood flow through the heart valves or near the heart. […] There are several ways in which your health care provider may describe a murmur: […] Murmurs are classified („graded”) depending on how loud the murmur sounds with a stethoscope. The grading is on a scale. Grade I can barely be heard and is intermittent. An example of a murmur description is a „grade II/VI murmur.” (This means the murmur is grade 2 on a scale of 1 to 6). […] In addition, a murmur is described by the stage of the heartbeat when the murmur is heard. A heart murmur may be described as systolic or diastolic. (Systole is when the heart is squeezing out blood and diastole is when it is filling up with blood.)

• #1 Abnormal and

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/innocent-heart-murmur

  A heart murmur is an unusual heart sound. Many times a heart murmur isn’t dangerous and is called an “innocent” murmur. Abnormal heart murmurs may point to an underlying heart condition that should be studied further. […] Abnormal heart murmurs in adults are usually related to defective heart valves. […] Heart murmurs related to valve problems should receive follow-up care. […] If a murmur is detected, follow-up tests may be recommended. Although some heart murmurs indicate heart valve problems, others are considered harmless. These are “innocent” murmurs. […] Your health care professional will investigate the root cause of the heart murmur. Clues about the cause can be based on the loudness, location and quality of the murmur. […] The location, duration and loudness of the murmur can help your health care provider determine which heart valve is involved as well as the severity.

• #1 Evaluation and Management of Heart Murmurs in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1001/p793.html

  In children and adolescents, the diagnosis of an innocent heart murmur can be made if four criteria are met: absence of abnormal physical examination findings (except for the murmur); a negative review of systems (i.e., child is asymptomatic); a history that is negative for features that increase the risk of structural heart disease; and characteristic auscultatory features of a specific innocent heart murmur. […] When an innocent murmur cannot be definitively diagnosed, the child should be referred for echocardiography, to a pediatric cardiologist, or both. […] Newborns are at higher risk of having serious structural heart disease that presents as an asymptomatic murmur. […] Because of the higher likelihood of structural heart disease in asymptomatic newborns and young infants with heart murmurs, referral to a pediatric cardiologist and/or for echocardiography is recommended.

• #1 Heart Murmurs in Children: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0300/p250.html

  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. […] 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. […] 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.

• #1 Heart Murmurs in Children: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0300/p250.html

• #1 Heart Murmurs in Children: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0300/p250.html

  Emerging technologies include phonocardiography interpretation of murmurs and artificial intelligence algorithms for differentiating innocent from pathologic murmurs. […] The development of a new murmur, particularly in association with fever, may indicate several possible conditions. […] A step-by-step approach for the evaluation of murmurs in infants who are nonsyndromic, including referral indications, is provided in Figure 1. Pediatric cardiology referral should occur for murmurs during the initial hospitalization when signs or symptoms of cardiac disease are present, the critical congenital heart screening results are abnormal, syndromic features are present, there is a history of abnormal fetal echocardiography, or a first-degree relative with congenital heart disease. […] Echocardiography is appropriate for a murmur associated with signs or symptoms of cardiovascular disease or with pathologic sounding murmurs. However, as above, a cardiology referral is often the more appropriate approach. […] Although most murmurs in older children are innocent murmurs, certain findings suggest the possibility of a pathologic murmur.

• #1 Cardiac murmurs in children

  https://www1.racgp.org.au/ajgp/2024/july/cardiac-murmurs-in-children

  The use of digital intelligent phonocardiograms is a cost-effective method for detecting significant cardiac murmurs in newborns, potentially improving CHD detection rates by an additional 58%. […] Indications for referral to local paediatric cardiology services are as follows: age under three months (any murmur), if ARF or RHD is suspected (any age), known CHD relocating to the area, if an abnormality is detected in a detailed foetal morphological scan, infants and children aged over three months with a pathological murmur (when an innocent murmur cannot be diagnosed), when there is a family history of CHD in first-degree relatives, Marfan syndrome, cardiomyopathy or unexplained sudden death, if the child is known to have chromosomal or genetic conditions that are associated with heart diseases, failure to thrive, poor growth, difficulty in feeding, abnormal symptoms such as breathlessness, frequent chest infections, unable to keep up with friends, cardiac symptoms such as palpitations, syncope or chest pain, other abnormal cardiac signs (clubbing, cyanosis, clicks or added sounds, rapid heart rate or high blood pressure). […] Significant skill and knowledge are required for the identification of critical murmurs and associated cardiovascular problems.

• #1 Diagnosing Heart Murmurs: When Should You Be Concerned? | Henry Ford Health – Detroit, MI

  https://www.henryford.com/blog/2022/12/diagnosing-heart-murmurs

  An echocardiogram. Performing an ultrasound on the heart is the best way doctors can evaluate the type of murmur you have and determine what steps need to be taken if there is cause for concern. […] From a medical standpoint, heart murmurs are really a god-sent, says Dr. Frisoli. They give clinicians an opportunity to make a medical diagnosis with just a stethoscope. A cardiologist with a trained ear can make early diagnoses of valve problems, allowing treatment or surgical intervention to take place sooner rather than later. […] In some cases, heart murmurs are an early sign of serious complications with the heart. Surgery is often necessary if it is determined that your heart murmur is related to conditions such as heart disease or a heart valve disease. Taking action early can prevent a heart complication from having serious impact on your life and allow you to make lifestyle modifications to improve your health overall. […] Your doctor will work with you to determine the best course of action for treatment. If you notice sudden changes in your health after being diagnosed with a heart murmur, be sure to seek medical attention right away as this could be the result of a complication related to the heart murmurs.

• #1 Heart Murmur: Symptoms & Treatments | University of Utah Health

  https://healthcare.utah.edu/cardiovascular/conditions/heart-murmur

  Not all heart murmurs need to be treated with surgery. Instead, your treatment will depend on whats causing your heart murmur in the first place. […] If something is wrong with your heartfor example, if you have a hole in your heart or one of your heart valves needs to be replacedthen you may need surgery. […] Surgeries for heart murmurs often include valve repair and valve replacement. These surgeries treat the underlying valve problems in your heart that are causing the murmur. […] Many heart murmurs are innocent and dont need treatment. But its important to see a cardiologist or cardiothoracic surgeon if: […] Your heart team will examine your heart and rule out any serious, undiagnosed heart conditions that may need treatment.

• #1 Initial evaluation of heart murmurs: are laboratory tests necessary? – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2216611/

  Heart murmurs, most of them innocent, are the most common reason for referrals to a pediatric cardiologist. […] The purpose of this study was to determine the utility of these examinations in the initial assessment of heart murmurs in children and adolescents. […] The clinical examination by an experienced pediatric cardiologist is an accurate means of assessing newly referred patients with murmurs. The clinical examination had a sensitivity of 96%, specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%. […] Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in pediatric patients with clinically diagnosed innocent heart murmurs.

• #2 Heart murmur – Wikipedia

  https://en.wikipedia.org/wiki/Heart_murmur

  Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. The sound differs from normal heart sounds by their characteristics. For example, heart murmurs may have a distinct pitch, duration and timing. The major way health care providers examine the heart on physical exam is heart auscultation; another clinical technique is palpation, which can detect by touch when such turbulence causes the vibrations called cardiac thrill. A murmur is a sign found during the cardiac exam. Murmurs are of various types and are important in the detection of cardiac and valvular pathologies (i.e. can be a sign of heart diseases or defects). […] A medical provider (e.g. doctor) may order tests for further evaluation of a heart murmur. The echocardiogram is a common test used. This is also known as an „echo” or ultrasound of the heart. It shows the heart structures and blood flow through the heart. Further testing is usually done when symptoms that may be of concern are present.

• #2 Physiology, Cardiovascular Murmurs – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525958/

  Cardiac auscultation is an essential physical exam tool for providers. Comprehension of anatomy, physiology, and underlying physics, with mastery of physical examination, can uncover many potential pathologies and prevent serious complications. In trained individuals, sensitivity and specificity for murmurs can reach 70% and 98%, respectively. Since early detection of cardiac murmurs can be essential to reducing morbidity and mortality, healthcare providers should master these murmurs and their common etiologies. […] Murmurs are identifiable through auscultation using a manual or electronically enhanced stethoscope. Description of murmurs is made using the following criteria, explained below: location, quality, and timing. […] Most murmurs will increase or decrease in volume when the patient performs certain maneuvers. This dynamic quality of murmurs is used as a clinical tool during the patient’s physical exam to aid in diagnosing a specific murmur.

• #2 Diastolic Murmurs Exam | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/DiastolicMurmursExam.html

  Diastolic murmurs are commonly encountered findings on the auscultation of the heart, both in the outpatient and inpatient setting. The physical exam, when performed correctly, can by itself help determine the underlying cause of a diastolic murmur. […] Diastolic murmurs are always a pathological finding on the auscultation of the heart, indicating the presence of a valvular abnormality. The physical exam can, by itself, reveal the cause of a diastolic murmur. However, it is very important to perform the physical exam with the right technique in order to maximize our chances to identify a diastolic murmur and determine its cause. […] The murmur of aortic regurgitation is loudest at the left lower sternal border, around the 3rd and 4th intercostal spaces. […] The diastolic murmur of pulmonary regurgitation is very similar to the one of aortic regurgitation. It is a decrescendo diastolic murmur with a blowing character.

• #2 Diagnosis of Heart Disease in Animals – Circulatory System – Merck Veterinary Manual

  https://www.merckvetmanual.com/circulatory-system/diagnosis-of-heart-disease/diagnosis-of-heart-disease-in-animals

  Diastolic murmurs are typically decrescendo (decreasing in intensity through diastole) and usually the result of aortic insufficiency (such as the insufficiency due to aortic valve infectious endocarditis in dogs or degenerative disease in horses). Diastolic murmurs may sound like a dive-bomber or grunting. […] A continuous murmur is most commonly the result of patent ductus arteriosus and occurs throughout systole and diastole. A continuous murmur varies in intensity over time, typically being most intense at the end of ventricular ejection (the second heart sound) and then decreasing in intensity through diastole. The term „to-and-fro murmur” describes a murmur that occurs both in systole and in diastole (eg, in an animal with subaortic stenosis and aortic insufficiency). […] Heart murmur intensity is classified as follows: Grade 1: the lowest-intensity murmur that can be heard, typically detected only when auscultation is performed in a quiet room; Grade 2: a faint murmur but easily audible, and restricted to a localized area; Grade 3: a murmur immediately audible when auscultation begins in the correct location; Grade 4: a loud murmur immediately heard at the beginning of auscultation but not accompanied by a thrill; Grade 5: a very loud murmur with a palpable thrill; Grade 6: an extremely loud murmur with a thrill that can be heard when the stethoscope is removed from the chest wall.

• #2 Physiology, Cardiovascular Murmurs – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK525958/

  Symptomatic patients presenting with new murmurs are always investigated with imaging. An echocardiogram is preferred to evaluate cardiac structure and function because of its practicality, sensitivity, and specificity for detecting valvular diseases. […] When combined with an accurately identified murmur, a patient history can provide critical details that lead to diagnosis. […] In addition to patient history, obtaining a detailed cardiovascular physical examination is paramount in identifying a murmur and its associated disease. […] Murmurs are critical physical examination findings in many patients. Many diseases have associated murmurs. Fortunately, each murmur often has enough distinguishing qualities that, when combined with patient history, allows the physician to create a concise list of possible diagnoses. Imaging such as an echocardiogram is essential for a definitive diagnosis of any underlying cardiac disease.

• #2 Heart Murmurs in Dogs | VCA Animal Hospitals

  https://vcahospitals.com/know-your-pet/heart-murmurs-in-dogs

  Depending on what other clinical signs are present in your dog, your veterinarian will usually recommend X-rays, an electrocardiogram (ECG), or an ultrasound examination of the heart (echocardiogram). […] An echocardiogram that includes a Doppler examination is the most useful test to determine the location of a heart murmur. […] Treatment depends upon the underlying cause of the heart murmur or the turbulent blood flow. […] If the murmur is caused by extracardiac disease or a functional problem that can be treated, the murmur may resolve over time. […] The prognosis ranges from excellent to grave, depending on the cause of the murmur. […] Each case is different and your veterinarian will discuss the prognosis and treatment options that best suit your dog’s unique needs.

• #2 Heart Murmurs Diagnosis | Temple Health

  https://www.templehealth.org/services/conditions/heart-murmurs/diagnosis

  A heart murmur is usually found during a routine physical exam or when it causes symptoms. Once its basic characteristics (e.g., loudness, location, etc.) have been identified, your doctor may order additional tests to determine whether its an abnormal heart murmur caused by a larger, underlying problem. […] Tests that your doctor may use include: […] Electrocardiogram is a simple non-invasive test that can be done in the doctors office using small adhesive pads called electrodes that are placed on the arms, legs, and chest. […] Echocardiogram is a non-invasive test using ultrasound (sound waves) and a device called a transducerwhich is placed on the surface of the chestto create a moving picture of the heart. […] Heart catheterization is used to detect abnormalities of the heart valves, heart function and coronary arteries.

• #2 Heart Murmurs | The Texas Heart Institute®

  https://www.texasheart.org/heart-health/heart-information-center/topics/heart-murmurs/

  To find out if your heart murmur is innocent or if it is caused by another heart problem, your doctor may also order these tests: A chest x-ray to see if your heart is enlarged. Electrocardiography (ECG or EKG) to check for an irregular heartbeat (arrhythmia) or an enlarged heart. Echocardiography to see valve function, heart wall motion, and overall heart size. A special medicine called amyl nitrate that is used to define certain heart murmurs. Your doctor will have you breathe in the medicine, which briefly changes your blood pressure and heart rate. […] The treatment for a heart murmur depends on the cause. Innocent heart murmurs usually do not need to be treated. If your heart murmur is caused by an underlying condition, such as high blood pressure, your doctor will treat that condition. If your heart murmur is caused by disease of the valve itself (intrinsic valve disease) or other heart defects, medicines or surgery may be needed. […] In some patients, surgery may be needed to repair a heart defect or repair or replace a damaged heart valve.

• #2 Diagnosis of cardiac murmurs in children

  https://www.oaepublish.com/articles/2574-1209.2021.105

  It is essential that the patient is quiet, and the auscultation should take place in noiseless surroundings so as to ensure accurate interpretation of auscultatory findings. […] After the murmur is discovered, initially determine the timing of occurrence of the murmur, namely, systolic, diastolic, or continuous. […] The loudness of the murmur into grades I through VI should be appraised so that a comparison between different observers during the same visit or between examinations by the same observer at different visits can be made. […] While grading of the murmur is routinely performed by most cardiologists, the grade of the murmur does not indicate a given diagnosis or severity of the cardiac problem. […] The heart murmurs are classified into: (1) systolic; (2) diastolic; and (3) continuous murmurs.

• #2 Diagnosis of Heart Disease in Animals – Circulatory System – Merck Veterinary Manual

  https://www.merckvetmanual.com/circulatory-system/diagnosis-of-heart-disease/diagnosis-of-heart-disease-in-animals

  Heart murmurs are audible vibrations (sound) emanating from the heart or major blood vessels. The vast majority are due to turbulence created by high-velocity blood flow that produces a mixed-frequency murmur. Much less commonly, murmurs are due to vibrations of cardiac structures such as part of a valve leaflet or chordal structure that produces a single frequency (musical) murmur. Murmurs are typically defined relative to timing (systole, diastole, continuous); intensity (grades 1-6); and location (eg, left apex, left base). They can also be characterized by frequency (pitch); quality (eg, musical); and configuration (eg, crescendo-decrescendo). […] A systolic murmur is typically described as either ejection (crescendo-decrescendo) or regurgitant (holosystolic, plateau). However, making this distinction is often difficult, even for an experienced examiner, especially when the heart rate is fast. Ejection-quality systolic murmurs typically demonstrate the greatest intensity during mid systole and appear diamond shaped on phonocardiography. Systolic murmurs are most commonly produced by stenotic lesions at the semilunar valves (eg, pulmonic stenosis or subaortic stenosis). A classic regurgitant systolic murmur demonstrates a constant intensity throughout systole and is commonly due to mitral or tricuspid regurgitation (eg, myxomatous degeneration of the mitral valve) or a ventricular septal defect. However, these murmurs may also change intensity during systole.

• #2 Checking for heart murmurs – Harvard Health

  https://www.health.harvard.edu/heart-health/checking-for-heart-murmurs

  A heart murmur is the sound of turbulent blood flow within the heart as heard through a stethoscope. […] Doctors classify heart murmurs into two main categories: benign (also called innocent or functional murmurs) and abnormal (also called structural or pathologic murmurs). […] When evaluating a heart murmur, a doctor will listen to your heart from different locations on your chest and back and may ask you do things that create subtle, temporary changes in blood flow through your heart, such as inhaling, gripping your hands, sitting, squatting, standing up quickly, or lying down. […] If a murmur is detected, you’ll need additional tests to determine the cause. These can include an echocardiogram (ultrasound of the heart), an electrocardiogram (which records the heart’s electrical activity), and a chest x-ray.

• #2 Diagnosing Heart Murmurs: When Should You Be Concerned? | Henry Ford Health – Detroit, MI

  https://www.henryford.com/blog/2022/12/diagnosing-heart-murmurs

  Does having a heart murmur mean you need heart surgery? According to Tiberio Frisoli, M.D., a cardiologist at Henry Ford Health, thats not necessarily true. […] When a newly acquired heart murmurs is first heard, your doctor will want to conduct an ultrasound of the heart, called an echocardiogram to identify if there is some sort of valve problem, says Dr. Frisoli. If a valve problem is identified, medical intervention may be necessary. […] There are a few different ways through which a heart murmur might be diagnosed: Your primary care provider. Theres a reason your doctor listens to your heart at regular wellness visits. Primary care doctors can often be the first to hear a murmur and direct you to further testing or a cardiologist to determine the murmurs cause. […] A cardiologist. Cardiologists are specialty trained to listen for heart murmurs. Different types of heart murmurs make different sounds and the location of where you can hear that sound the loudest can help identify the murmur. Your doctor will listen for noise around the apex of the heart and throughout the chest to determine what area of the heart is causing the murmur.

• #2 Heart Murmurs: Evidence Based Strategies | Children’s Mercy Kansas City

  https://www.childrensmercy.org/health-care-providers/refer-or-manage-a-patient/connect-with-childrens-mercy/newsletter-the-link/link-newsletter-june-2023/evidence-based-strategies-heart-murmurs/

  A new murmur, especially if harsh, might understandably set a physicians own heart racing. An estimated 50%-80% of children will have a cardiac murmur at some point in their life, but less than 1% of these murmurs will correlate with serious congenital or acquired heart disease, making identifying a pathologic murmur akin to finding a needle in a haystack. Here, we highlight the characteristics of heart murmurs, including timing, intensity, location and variability that should appropriately raise concern and prompt further evaluation, compared to those that can be observed. Timing of a murmur is the first important characteristic to consider. An S1 co-incident murmur starts at the onset of systole and may blur S1. These and pansystolic murmurs raise concern for a pathology, such as a ventricular septal defect. Most continuous murmurs and all diastolic murmurs should be further evaluated. Next, we evaluate the intensity of a murmur, keeping in mind that the intensity of a murmur does not always correlate with severity of a condition. Most pathologic murmurs are found to be greater than grade 3, and thus should be further evaluated. The quality of a murmur should also be considered, with harsh or blowing murmurs more worrisome, and sweet or musical murmurs less likely to indicate pathology. The location of most prominent auscultation as well as radiation of a murmur can also be helpful in evaluation. Location of maximum murmur intensity may help determine which anatomic component is affected, but murmurs that radiate throughout the precordium should be further evaluated. Lastly, we decide if a murmur is variable in different positions or with special maneuvers. A murmur that intensifies with standing should be referred, while a murmur that gets louder in the supine position as venous return to the heart increases may indicate an innocent Stills murmur. Most murmurs referred to pediatric cardiologists for further evaluation are innocent, indicating that much of the parental anxiety surrounding these visits was preventable. In a study reporting the prevalence of significant cardiac pathology in patients 2-18 years of age referred to cardiology for a murmur, 33/473 (7%) were diagnosed with cardiac pathology. For asymptomatic children found to have new murmurs with innocent features, conservative management with observation alone should be considered. This approach may help mitigate excess resource use and parental anxiety. Of course, any child with a murmur and associated concerning signs or symptoms such as poor growth, tachypnea or exercise intolerance should also undergo further evaluation and referral.

• #2 Heart Murmurs in Children: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0300/p250.html

  Emerging technologies include phonocardiography interpretation of murmurs and artificial intelligence algorithms for differentiating innocent from pathologic murmurs. […] The development of a new murmur, particularly in association with fever, may indicate several possible conditions. […] A step-by-step approach for the evaluation of murmurs in infants who are nonsyndromic, including referral indications, is provided in Figure 1. Pediatric cardiology referral should occur for murmurs during the initial hospitalization when signs or symptoms of cardiac disease are present, the critical congenital heart screening results are abnormal, syndromic features are present, there is a history of abnormal fetal echocardiography, or a first-degree relative with congenital heart disease. […] Echocardiography is appropriate for a murmur associated with signs or symptoms of cardiovascular disease or with pathologic sounding murmurs. However, as above, a cardiology referral is often the more appropriate approach. […] Although most murmurs in older children are innocent murmurs, certain findings suggest the possibility of a pathologic murmur.

• #2 Cardiac murmurs in children

  https://www1.racgp.org.au/ajgp/2024/july/cardiac-murmurs-in-children

  The use of digital intelligent phonocardiograms is a cost-effective method for detecting significant cardiac murmurs in newborns, potentially improving CHD detection rates by an additional 58%. […] Indications for referral to local paediatric cardiology services are as follows: age under three months (any murmur), if ARF or RHD is suspected (any age), known CHD relocating to the area, if an abnormality is detected in a detailed foetal morphological scan, infants and children aged over three months with a pathological murmur (when an innocent murmur cannot be diagnosed), when there is a family history of CHD in first-degree relatives, Marfan syndrome, cardiomyopathy or unexplained sudden death, if the child is known to have chromosomal or genetic conditions that are associated with heart diseases, failure to thrive, poor growth, difficulty in feeding, abnormal symptoms such as breathlessness, frequent chest infections, unable to keep up with friends, cardiac symptoms such as palpitations, syncope or chest pain, other abnormal cardiac signs (clubbing, cyanosis, clicks or added sounds, rapid heart rate or high blood pressure). […] Significant skill and knowledge are required for the identification of critical murmurs and associated cardiovascular problems.

• #2 Heart Murmurs: Causes, Symptoms, and How to Fix Them

  https://www.verywellhealth.com/heart-murmur-explained-3157001

  A heart murmur is an extra or abnormal sound that is heard when listening to your heart through a stethoscope (also known as cardiac auscultation). […] This article describes the symptoms and causes of a heart murmur. It also explains how heart murmurs are diagnosed and what can be done to fix or manage a serious heart murmur. […] Your healthcare provider or a heart specialist called a cardiologist may detect a heart murmur during your routine medical examination. […] If a heart murmur is accompanied by symptoms of heart disease (or you are older and have risk factors for heart disease), your provider may order tests to help pinpoint the cause. […] These tests may include: […] In most cases, the cause of a heart murmur is diagnosed with a non-invasive echocardiogram. […] Some heart murmurs are caused by conditions that require surgery and/or medical management, while some do not require any intervention at all.

• #2 Abnormal and

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/innocent-heart-murmur

  Other tests may be done to decide if the murmur needs further investigation including: Chest X-ray, Electrocardiogram (ECG), Echocardiogram, Cardiac catheterization. […] Any time a murmur is suspected to be associated with a valve problem that may need treatment or repair, it’s wise to look for a qualified health care professional with experience diagnosing and treating your condition.

• #2 Heart Murmur: Symptoms & Treatments | University of Utah Health

  https://healthcare.utah.edu/cardiovascular/conditions/heart-murmur

  If your doctor told you that you have a heart murmur, youre probably wondering what that means. […] Whether you need treatment for your heart murmur will depend on what type of murmur you have. […] Many heart murmurs arent life-threatening and dont need treatment. But other heart murmurs do need treatment because theyre a sign of an underlying problem with your heart. […] Whether a heart murmur is dangerous depends on whats causing it in the first place. […] Heart murmurs that are caused by diseases or structural problems in your heart may need treatment. […] Heart murmurs that are caused by infections, birth defects, or diseases can be dangerous. […] Cardiologists and cardiothoracic surgeons are doctors who specialize in treating heart valve diseases. These doctors can recognize and diagnose valve diseases that may be missed by other doctors.

• #3 Heart Murmurs | The Texas Heart Institute®

  https://www.texasheart.org/heart-health/heart-information-center/topics/heart-murmurs/

  Normal heart sounds come in pairs. […] But if there is a problem, a murmur may be added to this normal “lub-dub.” By using a stethoscope to listen to your heart, your doctor’s trained ear can tell if the abnormal sound indicates turbulence. This is called a heart murmur. […] While some heart murmurs are innocent, others are a sign of a more serious heart problem. In these cases, the sound may indicate that blood is flowing through a damaged or overworked heart valve, that there may be a hole in one of the heart’s walls, or that there is a narrowing in one of the heart’s vessels. […] In most cases, your doctor will be able to hear your heart murmur by using a stethoscope to listen to your heart (a technique called cardiac auscultation). Heart murmurs change as your body position or breathing changes, so you may be asked to stand up, squat, lie down, breathe deeply, or hold your breath while the doctor listens to your heart.

• #3 Abnormal and

  https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/innocent-heart-murmur

  Other tests may be done to decide if the murmur needs further investigation including: Chest X-ray, Electrocardiogram (ECG), Echocardiogram, Cardiac catheterization. […] Any time a murmur is suspected to be associated with a valve problem that may need treatment or repair, it’s wise to look for a qualified health care professional with experience diagnosing and treating your condition.

• #3 Heart Murmur I Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/heart-rhythm/heart-murmur

  Heart murmurs can be due to congenital heart defects and vary in severity. […] A heart murmur is an unusual or extra sound heard during a heartbeat. Murmurs can range from faint to loud, and often sound like a whooshing or swishing noise. Heart murmurs can be due to congenital heart defects, valve abnormalities, infections in the heart or heart failure. Some heart murmurs are harmless, while others indicate a serious abnormality. […] If you have these symptoms, a physician experienced in heart conditions should evaluate you. […] A physician listening to the heart with a stethoscope during a routine physical examination detects most heart murmurs. Heart murmurs are graded on a scale from 1-6, with six reflecting the loudest murmur. […] Tests a physician uses to confirm the diagnosis of a pathologic heart murmur include: Electrocardiogram (EKG/ECG) A test that records the electrical activity of the heart, Echocardiogram (also called echo) This test uses sound waves to assess the function and structure of the heart muscle and valves, Cardiac MRI (cardiac magnetic resonance imaging or CMR) A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating, Cardiac catheterization A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.

• #3 Diagnosis of Heart Disease in Animals – Circulatory System – Merck Veterinary Manual

  https://www.merckvetmanual.com/circulatory-system/diagnosis-of-heart-disease/diagnosis-of-heart-disease-in-animals

  Diastolic murmurs are typically decrescendo (decreasing in intensity through diastole) and usually the result of aortic insufficiency (such as the insufficiency due to aortic valve infectious endocarditis in dogs or degenerative disease in horses). Diastolic murmurs may sound like a dive-bomber or grunting. […] A continuous murmur is most commonly the result of patent ductus arteriosus and occurs throughout systole and diastole. A continuous murmur varies in intensity over time, typically being most intense at the end of ventricular ejection (the second heart sound) and then decreasing in intensity through diastole. The term „to-and-fro murmur” describes a murmur that occurs both in systole and in diastole (eg, in an animal with subaortic stenosis and aortic insufficiency). […] Heart murmur intensity is classified as follows: Grade 1: the lowest-intensity murmur that can be heard, typically detected only when auscultation is performed in a quiet room; Grade 2: a faint murmur but easily audible, and restricted to a localized area; Grade 3: a murmur immediately audible when auscultation begins in the correct location; Grade 4: a loud murmur immediately heard at the beginning of auscultation but not accompanied by a thrill; Grade 5: a very loud murmur with a palpable thrill; Grade 6: an extremely loud murmur with a thrill that can be heard when the stethoscope is removed from the chest wall.

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