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Causes of Mitral-valve prolapse

Contents
  1. Mitral-valve prolapse: Introduction
  2. List of Causes
  3. Hidden causes
  4. Excerpts from book chapters
  5. Complication causes
  6. Causes of symptoms
  7. News
  8. Related cause information

List of causes of Mitral-valve prolapse

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Mitral-valve prolapse) that could possibly cause Mitral-valve prolapse includes:

  • Rheumatic fever - once a common cause of MVP
  • Now less common due to antibiotic treatment of rheumatic fever

Mitral-valve prolapse Causes: Book Excerpts

Mitral-valve prolapse as a complication of other conditions:

Other conditions that might have Mitral-valve prolapse as a complication may, potentially, be an underlying cause of Mitral-valve prolapse. Our database lists the following as having Mitral-valve prolapse as a complication of that condition:

Mitral-valve prolapse as a symptom:

Conditions listing Mitral-valve prolapse as a symptom may also be potential underlying causes of Mitral-valve prolapse. Our database lists the following as having Mitral-valve prolapse as a symptom of that condition:

What causes Mitral-valve prolapse?

Article excerpts about the causes of Mitral-valve prolapse:
The heart's valves work to maintain the flow of blood in one direction, ensuring proper circulation. The mitral valve controls the flow of blood into the left ventricle. Normally, when the left ventricle contracts, the mitral valve closes and blood flows out of the heart through the aortic valve and into the aorta to start its journey to all other parts of the body.

In MVP, the shape or dimensions of the leaflets of the valve are not ideal; they may be too large and fail to close properly or they balloon out, hence the term "prolapse." When the valve leaflets flap, a clicking sound may be heard. Sometimes the prolapsing of the mitral valve allows a slight flow of blood back into the left atrium. This is called "mitral regurgitation," and may cause a sound called a murmur. Some people with MVP have both a click and a murmur and some have only a click. Many have no unusual heart sounds at all; those who do may have clicks and murmurs that come and go. (Source: excerpt from Facts About Mitral-Valve Prolapse: NHLBI)

Medical news summaries relating to Mitral-valve prolapse:

The following medical news items are relevant to causes of Mitral-valve prolapse:

Related information on causes of Mitral-valve prolapse:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Mitral-valve prolapse may be found in:

Causes of Mitral-valve prolapse: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Mitral-valve prolapse.

Murmurs - Diastolic: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Aortic insufficiency
    –Decrescendo murmur heard best at the right second intercostal space
  • Austin Flint murmur
    –Late diastolic rumble of severe aortic regurgitation
    –A result of aortic regurgitation so severe that it causes diastolic mitral regurgitation
  • Mitral stenosis
    –Opening snap with mid-diastolic rumble, especially in the left lateral decubitus position
  • Pulmonary insufficiency
    –Accentuated P2 and decrescendo murmur at the left second/third intercostal spaces
  • Tricuspid stenosis
    –Mid-diastolic rumble at the left sternal border
    –Increases with inspiration
  • Cervical venous hum (disappears upon pressure to the jugular vein)
  • Hepatic venous hum (disappears with epigastric pressure)
  • Mammary souffle (in pregnancy; disappears on compressing breast)
  • PDA (continuous machinery sound)
  • Coronary or pulmonary arteriovenous fistula
  • Coarctation of the aorta
  • ASD with left-to-right shunt
  • Atrial myxoma (“tumor plop”)
  • Pericardial knock (constrictive pericarditis)
  • Bronchial collaterals (congenital heart disease)
  • Anomalous pulmonary venous drainage with left-to-right shunt
  • Pulmonary artery branch stenosis
  • Carey-Coombs murmur (mid-diastolic murmur that occurs in acute rheumatic fever)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Murmurs - Systolic: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Innocent systolic murmur
    –Heard at left sternal border
    –Increased when supine
    –May be caused by increased flow states (e.g., anemia, hypovolemia, fever)
  • Still's murmur
  • Mitral valve prolapse
    –Midsystolic click with late systolic murmur that shifts with maneuvers
  • Aortic stenosis
    –Right side at second intercostal space
    –Radiates to carotid arteries
  • Aortic sclerosis
    –Right side at second intercostal space
    –Midsystole
  • Hyperthyroidism
  • Cervical venous hum
    –Disappears with jugular vein pressure
  • Hepatic venous hum
    –Disappears with epigastric pressure
  • Mammary souffle
    –Occurs in pregnancy
    –Disappears upon compression of breast
  • Bicuspid aortic valve
    –Right side at second intercostal space
    –Little radiation
    –Possible early diastolic aortic murmur
    –Opening sound of aortic valve heard in early systole (systolic ejection click)
  • Mitral insufficiency
    –Holosystolic murmur heard best in the left lateral decubitus position
    –S1 is usually diminished in intensity
  • Tricuspid insufficiency
    –Holosystolic murmur at second/third intercostal spaces
  • Endocarditis
    –Abrupt onset of new murmur
  • Peripheral pulmonary artery stenosis
  • Atrial or ventricular septal defect
  • Ventricular septal defect
  • Patent ductus arteriosus (continuous machinery sound, second left intercostal space)
  • Coarctation of the aorta
  • Left ventricular outflow tract obstruction
  • Pulmonary artery stenosis
  • Prosthetic valve noises
  • Pericardial friction rubs
  • Papillary muscle dysfunction
  • Pulmonic outflow obstruction
  • Coronary/pulmonary arteriovenous fistula

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Murmurs: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Aortic insufficiency

Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.

Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur — a rumbling, mid-to-late diastolic murmur best heard at the apex — may also occur. Complications may not develop until the patient is between ages 40 to 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.

Aortic stenosis

With aortic stenosis, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.

If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical, but is absent when the valve is severely calcified. Associated signs and symptoms usually don’t appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.

Cardiomyopathy (hypertrophic)

Hypertrophic cardiomyopathy generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.

Mitral insufficiency

Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.

Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.

Mitral prolapse

Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.

Mitral stenosis

With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap — a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise helps make this murmur audible.

With severe stenosis, the murmur of mitral regurgitation may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.

Myxomas

A left atrial myxoma (most common) usually produces a mid- diastolic murmur and a holosystolic murmur that’s loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.

A right atrial myxoma causes a late diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.

A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border; arrhythmias; dyspnea; and syncope.

A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It’s accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.

Papillary muscle rupture

With papillary muscle rupture — a life-threatening complication of an acute MI — a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.

Rheumatic fever with pericarditis

A pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral regurgitation, a midsystolic murmur due to swelling of the mitral valve leaflet, and the diastolic murmur of aortic regurgitation. Other signs and symptoms include a fever, joint and sternal pain, edema, and tachypnea.

Tricuspid insufficiency

Tricuspid insufficiency is a valvular abnormality that’s characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign), decreases with exhalation and Valsalva’s maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy asymptomatic period, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.

Tricuspid stenosis

Tricuspid stenosis is a valvular disorder that produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.

Other causes

Treatments

Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Murmurs: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Aortic insufficiency

Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.

Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur—a rumbling, mid-to-late diastolic murmur best heard at the apex—may also occur. Complications may not develop until ages 40 to 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.

Aortic stenosis

With this valvular disorder, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.

If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical but is absent when the valve is severely calcified. Associated signs and symptoms usually don’t appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.

Cardiomyopathy (hypertrophic)

This disorder generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.

Mitral insufficiency

Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.

Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.

Mitral prolapse

This disorder generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.

Mitral stenosis

With this valvular disorder, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap—a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise will help make this murmur audible.

With severe stenosis, the murmur of mitral insufficiency may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.

Myxomas

A left atrial myxoma (most common) usually produces a middiastolic murmur and a holosystolic murmur that’s loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.

A right atrial myxoma causes a late diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.

A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border, arrhythmias, dyspnea, and syncope.

A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It’s accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.

Papillary muscle rupture

With this life-threatening complication of an acute MI, a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.

Rheumatic fever with pericarditis

A pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral insufficiency, a midsystolic murmur due to swelling of the leaflet of the mitral valve, and the diastolic murmur of aortic insufficiency. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.

Tricuspid insufficiency

This valvular abnormality is characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign), decreases with exhalation and Valsalva’s maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy asymptomatic period, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.

Tricuspid stenosis

This valvular disorder produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.

Other causes

Treatments

Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Diastolic Murmur: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Aortic regurgitation

❑ Pulmonic regurgitation

❑ Mitral stenosis

❑ Tricuspid stenosis

❑ Atrial septal defect

❑ Left anterior descending artery stenosis

❑ Atrial myxoma

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Systolic Murmur: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Systolic ejection murmur

❑ Mitral regurgitation

❑ Mitral valve prolapse

❑ Aortic stenosis

❑ Aortic valve sclerosis

❑ Hypertrophic obstructive cardiomyopathy

❑ Atrial septal defect

❑ Pulmonic stenosis

❑ Tricuspid regurgitation

❑ Ventricular septal defect

❑ Aortic coarctation

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Continuous Murmur: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Aortic stenosis/aortic insufficiency

❑ Pericardial friction rub

❑ Pulmonary arteriovenous fistula

❑ Venous hum

❑ Mammary souffle

❑ Aortic coarctation

❑ Mediastinal air dissection

❑ Patent ductus arteriosis

❑ Ruptured sinus of Valsalva

❑ Coronary artery fistula

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Murmurs: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Aortic insufficiency

Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.

Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur — a rumbling, mid-to-late diastolic murmur best heard at the apex — may also occur. Complications may not develop until ages 40 to 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.

Aortic stenosis

With aortic stenosis — avalvular disorder — the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.

If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical but is absent when the valve is severely calcified. Associated signs and symptoms usually don’t appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.

Cardiomyopathy (hypertrophic)

Cardiomyopathy generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.

Mitral insufficiency

Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.

Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.

Mitral prolapse

Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex and left sternal border. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.

Mitral stenosis

With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap — a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise will help make this murmur audible.

With severe stenosis, the murmur of mitral regurgitation may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.

Myxomas

A left atrial myxoma (most common) usually produces a middiastolic murmur and a holosystolic murmur that’s loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.

A right atrial myxoma causes a late diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.

A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border, arrhythmias, dyspnea, and syncope.

A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It’s accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.

Papillary muscle rupture

Papillary muscle rupture is a life-threatening complication of an acute MI, in which a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.

Rheumatic fever with pericarditis

A pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral regurgitation, a midsystolic murmur due to swelling of the leaflet of the mitral valve, and the diastolic murmur of aortic regurgitation. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.

Tricuspid insufficiency

Tricuspid insufficiency is a valvular abnormality that’s characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign), decreases with exhalation and Valsalva’s maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy asymptomatic period, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.

Tricuspid stenosis

Tricuspid stenosis is a valvular disorder that produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.

Other causes

Medical treatments

Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Murmurs: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Aortic insufficiency

Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.

Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur — a rumbling, mid-to-late diastolic murmur best heard at the apex — may also occur. Findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.

Aortic stenosis

With aortic stenosis, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.

If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical but is absent when the valve is severely calcified. Associated signs and symptoms may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.

Cardiomyopathy (hypertrophic)

Hypertrophic cardiomyopathy generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.

Mitral insufficiency

Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.

Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.

Mitral prolapse

Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.

Mitral stenosis

With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap — a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise will help make this murmur audible.

With severe stenosis, the murmur of mitral insufficiency may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.

Papillary muscle rupture

Papillary muscle rupture, a life-threatening complication of an acute MI, produces a loud holosystolic murmur that can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.

Rheumatic fever with pericarditis

A pericardial friction rub along with murmurs and gallops is heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard in patients with rheumatic fever are the systolic murmur of mitral insufficiency, a midsystolic murmur due to swelling of the leaflet of the mitral valve, and the diastolic murmur of aortic insufficiency. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.

Tricuspid insufficiency

Tricuspid insufficiency is a valvular abnormality that’s characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign) and decreases with exhalation and Valsalva’s maneuver. This murmur is best heard over the lower left sternal border and the xiphoid area. Following a lengthy period without symptoms, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.

Tricuspid stenosis

Tricuspid stenosis is a valvular disorder that produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.

Other causes

Treatments

Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Heart Murmurs (Asymptomatic): Principal Causes of Heart Murmurs (Asymptomatic)
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

  1. Normalmurmurs
    1. Systolicejection murmurs
      1. Vibratory systolic murmur
      2. Pulmonary systolic murmur (pulmonarytrunk)
      3. Physiologic peripheral pulmonary systolicmurmur (pulmonary branches)
      4. Supraclavicular or brachiocephalicmurmur
    2. Continuous murmurs
      1. Venoushum
  2. Pathologic murmurs
    1. Systolicmurmurs
      1. Maximalintensity at the upper right sternal border
        1. Valvaraortic stenosis
      2. Maximal intensity at the upper leftsternal border
        1. Valvar pulmonic stenosis
        2. Atrial septal defects
        3. Mild-to-moderate coarctation of theaorta
        4. Small patent ductus arteriosus
      3. Maximal intensity at the lower leftsternal border
        1. Ventricular septal defect
        2. Tricuspid incompetence
      4. Maximal intensity at the apex
        1. Mitralincompetence
        2. Mitral valve prolapse
    2. Diastolic murmurs
      1. Maximalintensity at the upper right sternal border
        1. Aorticvalve incompetence
      2. Maximal intensity at the upper leftsternal border
        1. Pulmonic valve incompetence
      3. Maximal intensity at the lower leftsternal border
        1. Atrial septal defects
        2. Tricuspid stenosis
        3. Moderate-to-severe tricuspid incompetence
      4. Maximal intensity at the apex
        1. Mitralstenosis
        2. Moderate-to-severe mitral incompetence
        3. Moderate left-to-right shunt lesions
    3. Continuous murmurs
      1. Maximalintensity at the upper left sternal border
        1. Moderate patent ductus arteriosus
      2. Maximal intensity at the left mid sternalborder
        1. Aorticpulmonary window
      3. Maximal intensity with variable location
        1. Coronaryarteriovenous fistula
        2. Systemic arteriovenous fistula

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Murmurs: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Aortic insufficiency.Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that's best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.

Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that's best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur—a rumbling, mid-to-late diastolic murmur best heard at the apex—may also occur. Complications may not develop until the patient is between ages 40 and 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.

Aortic stenosis.With aortic stenosis, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It's harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb's point), and over the carotid arteries.

If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical, but is absent when the valve is severely calcified. Associated signs and symptoms usually don't appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.

Cardiomyopathy (hypertrophic).Hypertrophic cardiomyopathygenerates a harsh late-systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3 or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.

Mitral insufficiency.Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn't get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.

Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that's loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.

Mitral prolapse.Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.

Mitral stenosis.With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap—a cardinal sign. It's best heard at the apex with the patient in the left lateral position. Mild exercise helps make this murmur audible.

With severe stenosis, the murmur of mitral insufficiency may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.

Myxomas.A left atrial myxoma (most common) usually produces a mid-diastolic murmur and a holosystolic murmur that's loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.

A right atrial myxoma causes a late-diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.

A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border; arrhythmias; dyspnea; and syncope.

A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It's accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.

Papillary muscle rupture.With papillary muscle rupture—a life-threatening complication of an acute MI—a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.

Rheumatic fever with pericarditis.With rheumatic fever, a pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral insufficiency, a midsystolic murmur due to swelling of the mitral valve leaflet, and the diastolic murmur of aortic insufficiency. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.

Tricuspid insufficiency.Tricuspid insufficiency is characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo's sign), decreases with exhalation and Valsalva's maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy period without symptoms, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.

Tricuspid stenosis.Tricuspid stenosis produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva's maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.

Other causes

Treatments.Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007


 » Next page: Risk Factors for Mitral-valve prolapse

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