ABSTRACT
Introduction In most patients, suspicion of valvular heart disease arises from the finding of a murmur. Frequently, this is an incidental finding in a healthy individual or a patient with no symptoms referable to the cardiovascular system. It is important to reassure patients that a murmur is not synonymous with heart disease. Murmurs represent turbulent blood flow which may result from several possible conditions. These include: (i) increased flow secondary to anemia, fever, pregnancy, or a hyperadrenergic state; (ii) accelerated flow through a restricted orifice; (iii) forward flow through a normal valve into a dilated receiving chamber; (iv) regurgitant flow through a leaking valve; or (v) abnormal shunting between two chambers. In an unselected population, most systolic murmurs are physiologic, caused by conditions of increased blood flow (Shaver, 1995). By evaluating both the characteristics of the murmur and its context, the physician can usually distinguish the potentially serious from the innocent.
