Mitral Stenosis
Like aortic stenosis, in mitral valve stenosis, there’s a narrowing of the mitral valve orifice due to the deposition of calcium in this area. This is a common finding as a late-stage complication of rheumatic fever and causes a rumbling and low-pitched murmur sound located in the apex and heard when the patient is laying down on his left side.
Myxomas: This is a rare connective tissue tumor found in the heart and located in different parts depending on each case. They are more common in females, and their symptoms depend on the severity of the obstruction. The features of the murmuring sound are also variable depending on the location of the tumor.
Papillary muscle rupture: Papillary muscles are attached to the heart valves and are responsible for opening and closing them in every heartbeat. A break of these muscles is a fatal complication of myocardial infarction or endocarditis that causes severe blood regurgitation, and it is potentially fatal. Luckily, it is not common, and it is immediately perceived in the physical exam because the heart murmur is very loud.
Rheumatic fever with pericarditis: This is an inflammatory disease that occurs in patients with streptococcal pharyngitis. There’s a cross-reaction against bacterial proteins, and the immune system starts attacking normal heart tissue. This causes inflammation of the pericardium, one of the heart layers, which is known as pericarditis. In these cases, heart sounds are similar to a friction rub, and there’s a galloping sound instead of the normal heart sounds. Murmurs are systolic or mid-systolic, depending on the most affected heart valves.
Tricuspid insufficiency or stenosis: Similar to mitral valve insufficiency and mitral valve stenosis, the same can happen in the heart’s tricuspid valve. In these cases, the murmuring sound is high-pitched (in tricuspid insufficiency) or low-pithed and louder in inspiration (in tricuspid stenosis).
Prostatic valve replacement: After replacing valves with a prosthetic, some patients may develop a heart murmur depending on the valve. This is a variable outcome of the valve replacement surgery, and the nature of the sound depends on the location of the prosthetic valve, its composition, and the surgical technique.
Innocent murmurs in children: There is a variety of innocent murmurs found in babies and children. For example, still murmurs are located on the left side of the sternum at the same level as the nipple, and it quiets down when the child is lying on his stomach. A pulmonic murmur is located in the first left intercostal space, and there’s also a venous hum heard above the clavicles, which also quiets down when the child is looking sideways or down.