Flow Murmur

  • Flow murmurs may also be referred to as innocent, physiologic, benign, and systolic flow related.
  • They are typically systolic, short, soft (usually <3/6), crescendo-decrescendo in shape (early-peaking), and heard best over the base of the heart.
  • Flow murmurs in adults are usually the result of hyperdynamic circulation. An increase in blood flow across a structurally normal valve will cause turbulence and an associated murmur.
    • Common causes of hyperdynamic circulation include anemia, fever, exercise, pregnancy, and sepsis.

Patient 1:

This is a middle-aged patient with Laennec’s cirrhosis. She was noted to have a flow murmur on examination. Cirrhosis is a common cause of high output physiology.

Flow Murmur

Annotated

Patient 2:

This is a middle-aged woman with a flow murmur from cirrhosis.

Patient 3:

50-something year old woman with Laennec’s cirrhosis, admitted with nausea and vomiting. Found to have physical findings of cirrhosis, including spider angiomas and Terry’s nails. Unexpectedly found to have markedly elevated JVP and a loud systolic flow murmur, concerning for high-output HF. Echo revealed a markedly elevated stroke volume index (70 (ml/m2). Right heart catheterization showed elevated filling pressures, low SVR, but normal cardiac output. However, the patient was in a junctional bradycardia at the time of the RHC, with a HR around 40, so the bradycardia was speculated to falsely lower the cardiac output.