Echocardiography in a Patient with a New Murmur

  • Julie Friedman
  • Muhamed SaricEmail author


Heart murmurs are common in cardiac care unit (CCU) patients. As many of CCU patients are intubated and unable to provide medical history, the physical exam becomes crucial in piecing together a patient’s medical history. Once a new murmur is identified, echocardiography can be a helpful tool in the critical care setting to further elucidate the cardiac abnormalities of a CCU patient. Whereas many patients have murmurs representing manifestations of chronic diseases, this chapter focuses on the diagnosis and etiology of murmurs that are presumably new at the time of CCU admission and represent an acute change in clinical status.


Murmur Aortic valve disease Mitral valve disease 


  1. 1.
    Lessard E, Glick M, Ahmed S, Saric M. The patient with a heart murmur: evaluation, assessment and dental considerations. J Am Dent Assoc. 2005;136:347–56; quiz 80–1CrossRefPubMedGoogle Scholar
  2. 2.
    Bickley LS, Szilagyi PG, Bates B. Bates’ guide to physical examination and history-taking. 11th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013.Google Scholar
  3. 3.
    David L, Dumitrascu DL. The bicentennial of the stethoscope: a reappraisal. Clujul Med. 2017;90:361–3.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581–98.CrossRefPubMedGoogle Scholar
  5. 5.
    Lavie CJ, Gersh BJ. Mechanical and electrical complications of acute myocardial infarction. Mayo Clin Proc. 1990;65:709–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Bursi F, Enriquez-Sarano M, Nkomo VT, et al. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation. 2005;111:295–301.CrossRefPubMedGoogle Scholar
  7. 7.
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Birnbaum Y, Fishbein MC, Blanche C, Siegel RJ. Ventricular septal rupture after acute myocardial infarction. N Engl J Med. 2002;347:1426–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132:1435–86.CrossRefPubMedGoogle Scholar
  10. 10.
    Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. 2001;345:1318–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.CrossRefPubMedGoogle Scholar
  12. 12.
    Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest. 2005;128:296–302.CrossRefPubMedGoogle Scholar
  13. 13.
    Goldstein SA, Evangelista A, Abbara S, et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2015;28:119–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Zoghbi WA, Chambers JB, Dumesnil JG, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009;22:975–1014; quiz 82–4CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.New York University Langone Medical CenterNew YorkUSA

Personalised recommendations