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Could the murmur be extracardiac in origin? Extracardiac murmurs include the pericardial friction rub and cardiorespiratory murmurs.
Is the murmur continuous? A continuous murmur is most often due to ... DIAGNOSTIC WORKUP
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Is it acute or chronic? An acute cardiac arrhythmia should make one consider a myocardial infarction first.
Is the heart rate slow, normal, or fast? A rapid cardiac arrhythmia may be associated with hyperthyroidism, ... DIAGNOSTIC WORKUP
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Cardiac auscultation should be performed in a systematic manner. Normal heart sounds (S1, S2) should be identified, and the precordium should be examined for gallops (S3, S4) and additional heart sounds.
Differential ... Workup and Diagnosis ... Treatment
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The patient should be asked to describe the heart rhythm and to demonstrate it by either saying or tapping the speed and rhythm of the sensation. Additionally, teaching the patient to measure his or her pulse during the episode may give more clues as to the etiology of... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Diastolic heart murmurs are never normal and should always be further evaluated, in contrast to systolic murmurs, which are commonly benign or due to rapid flow rates. The part of the cardiac cycle that the murmur falls into (e.g. early, middle, or late) will help... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Systolic heart murmurs, in contrast to diastolic murmurs, may be normal or abnormal, although when coupled with a heave they are always abnormal. The part of the cardiac cycle that the murmur falls into (e.g., early, middle, or late) will help... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abnormal heart sounds are common in pediatric patients and usually benign. Approximately 50% of children will have an innocent murmur at some time, compared to a 1% incidence of congenital heart disease (nearly all of which present by 1 year of age).
... Workup and Diagnosis ... Treatment
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Heart failure exists when adequate cardiac output cannot be maintained either at rest or with activity. It can be either acute, chronic, or an acute decompensation of the chronic state, and represents a wide range of anatomic and pathophysiologic conditions. The three main categories are... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The first consideration on hearing a heart murmur is to determine whether the murmur is functional or organic. Certainly, the low-grade systolic murmurs tend to be functional; if the murmur changes or disappears on position, inspiration, or exercise it is
... READ EXCERPTS »
... With few exceptions, the etiologies of cardiac arrhythmias like those of bradycardia can best be recalled using the mnemonic VINDICATE. The exceptions are from one pathophysiologic cause: obstruction and consequent dilatation of one or
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient, who... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Left Heart Failure
Hypertensive heart disease
Coronary artery disease
Left ventricular diastolic dysfunction
Acute myocardial infarction
Aortic and mitral
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... Systolic
Early systolic
Physiologic (innocent)
Small ventricular septal defect
Large ventricular septal defect with pulmonary
... READ EXCERPTS »
... Arrhythmia (with or without digitalis intoxication)
Tachyarrhythmia
Ventricular fibrillation (e.g., prolonged QT syndromes)
... READ EXCERPTS »
... In valvular heart disease, three types of mechanical disruption can occur: stenosis, or narrowing, of the valve opening; incomplete closure of the valve; or prolapse of the valve. They can result from such disorders as endocarditis (most common),... Treatment ... Special considerations ... Pictures
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... Signs and Symptoms Loss of consciousness, absent pulse, apnea, anuria, cool extremities
Treatment (Tx) CPR, fluids, epinephrine, vasopressin, oxygen, mechanical ventilation, defibrillation, amiodarone, procainamide
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... In cardiac arrhythmias (sometimes called cardiac dysrhythmias), abnormal electrical conduction or automaticity changes heart rate and rhythm. (See Normal cardiac conduction, page 1126.) Arrhythmias vary in severity, from those that are mild,... Causes ... Signs and symptoms ... Diagnosis ... Special considerations ... Pictures
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... In cardiac tamponade, a rapid, unchecked rise in intrapericardial pressure impairs diastolic filling of the heart. The rise in pressure usually results from blood or fluid accumulation in the pericardial sac. If fluid accumulates rapidly,... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Left-sided: dyspnea, orthopnea, crackles, wheezing, hypoxia, respiratory acidosis, cough, cyanosis, palpitations, arrhythmias, elevated blood pressure, pulsus alternans; right-sided: dependent peripheral edema, hepatomegaly,... Treatment (Tx) ... Pictures
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... Acute rheumatic fever is a systemic inflammatory disease of childhood, in many cases recurrent, that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever and includes pancarditis (myocarditis,... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing can... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic, and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically... Emergency Interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... David E. Anisman and Gerald F. Farnell
A diastolic murmur is a finding that provides a clue to an underlying disease process. Unlike their systolic counterparts (Chapter 7.7), diastolic murmurs almost always indicate underlying heart... Approach ... History ... Physical examination (PE) ... Testing ... Diagnostic assessment ... Pictures
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... Dale Bishop
Systolic murmurs can herald significant clinical deterioration and sudden death, or they can represent stable or clinically insignificant conditions. Although technologic advances in cardiac diagnostic testing continue, auscultation... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Anthony F. Jerant
Congestive heart failure (CHF) is the most frequent reason for hospitalization among older adults in the United States. Nearly one-third of a national cohort of 170,239 Medicare enrollees hospitalized for the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Congestive heart failure
❑ Hypertensive left ventricular hypertrophy
❑ Anterior myocardial ischemia
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Phenomena
❑ S4 gallop
❑ Midsystolic click
❑ S3 gallop
❑ Loud S... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Aortic regurgitation
❑ Pulmonic regurgitation
❑ Mitral stenosis
❑ Tricuspid stenosis
❑ Atrial septal... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Systolic ejection murmur
❑ Mitral regurgitation
❑ Mitral valve prolapse
❑ Aortic stenosis
❑ Aortic... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Aortic stenosis/aortic insufficiency
❑ Pericardial friction rub
❑ Pulmonary arteriovenous fistula
❑ Venous hum
&... Diagnostic Approach ... Clinical Findings
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... In valvular heart disease, three types of mechanical disruption can occur: stenosis, or narrowing, of the valve opening; incomplete closure of the valve; or prolapse of the valve. They can result from such disorders as endocarditis (most common), congenital defects, and inflammation,... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... Abnormal electrical conduction or automaticity changes heart rate and rhythm in cardiac arrhythmias, also called cardiac dysrhythmias. (See Types of cardiac arrhythmias.)
Arrhythmias vary in severity, from those that... Causes ... Special considerations ... Pictures
... READ EXCERPTS »
... With cardiac tamponade, a rapid, unchecked rise in intrapericardial pressure impairs diastolic filling of the heart. The rise in pressure usually results from blood or fluid accumulation in the pericardial sac.
If fluid accumulates rapidly... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A syndrome characterized by myocardial dysfunction, heart failure leads to impaired pump performance (reduced cardiac output) or to frank heart failure and abnormal circulatory congestion. Congestion of systemic venous circulation may result in peripheral edema or hepatomegaly;... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Often recurrent, acute rheumatic fever is a systemic inflammatory disease of childhood that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever, including pancarditis (myocarditis,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by the patient, who... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They’re classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality. (See Classifying murmurs.)
... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic, and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported first by... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Normal murmursare due to turbulence of normal blood flow. A normal murmur does not result insymptoms. Cardiovascular exam, chest radiograph, and ECG are normal.Other terms used to signify a normal murmur are benign, insignificant,or innocent. ... Principal Causes of Heart Murmurs (Asymptomatic) ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Clinicalsyndrome resulting from inability of myocardium to meet metabolicdemands of body. Combination of tachypnea, tachycardia,cardiomegaly, and hepatomegaly is cardiac failure until proved otherwise. In many cases, several mechanisms are... Principal Causes of Cardiac Failure ... Clinical Features and Diagnosis ... Diagnostic Approach ... Table 7.1. Diagnostic Classification of Common Causes of CardiacFailure ... References
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... Murmurs are auscultatory sounds heard within the heart chambers or major arteries. They're classified by their timing and duration in the cardiac cycle, auscultatory location, loudness, configuration, pitch, and quality.
Timing can be... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... An abnormal pulse rhythm is an irregular expansion and contraction of the peripheral arterial walls. It may be persistent or sporadic and rhythmic or arrhythmic. Detected by palpating the radial or carotid pulse, an abnormal rhythm is typically reported... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
The first consideration on hearing a heart murmur is to determine
whether the murmur is functional or organic. Certainly, the low-grade
systolic murmurs tend to be functional; if the murmur changes or disappears
on position, inspiration, or exercise it is likely... Pictures
... READ EXCERPTS »
...
With few exceptions, the etiologies of cardiac arrhythmias like those
of bradycardia can best be recalled using the mnemonic VINDICATE. The
exceptions are from one pathophysiologic cause: obstruction and
consequent dilatation of one or more of the... Pictures
... READ EXCERPTS »
... Author:
Sarika Joshi, MD
What to Do - Take Action
Antibiotic prophylaxis for patients with certain types of heart disease (e.g.,
rheumatic heart disease, infective endocarditis, and congenital heart disease
[CHD]... Suggested Readings
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... Author:
Russell Cross, MD
What to Do - Make a Decision, Take Action
Ketamineisadirect-actinganestheticthatiswidelyusedinpediatricpractice
because of its dissociative properties and perceived beneficial cardiovascular
effects. It is frequently used in... Suggested Readings
... READ EXCERPTS »
... Chloe Brittan, MDPaul P. Wang, MD (4th Edition) Learning Problems - BASICS Learning Problems - description Learning disorders, or learning disabilities, are defined in the Diagnostic and ... Learning Problems - DIAGNOSIS ... Learning Problems - TREATMENT ... Learning Problems - FOLLOW UP ... Learning Problems - bibliography ... Learning Problems - CODES ... Learning Problems - FAQ
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... Judith A. Turow, MD Speech Problems - BASICS Speech Problems - description Language: A system of symbols with a systematic relationship that is used to communicate new ideas Speech: The expression of language in a ... Speech Problems - DIAGNOSIS ... Speech Problems - TREATMENT ... Speech Problems - FOLLOW UP ... Speech Problems - bibliography ... Speech Problems - CODES ... Speech Problems - FAQ
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Heart disease is the number one killer of American women, but it can be prevented. One way is to control your cholesterol levels. Find out how.
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