This presents as higher blood pressure in the arms and lower blood pressure in the legs. Harsh holosystolic (pansystolic) murmur at the left lower sternal border
Classic for a ventricular septal defect (VSD). This may lead to the development of the delayed-onset cyanotic heart disease known as Eisenmenger syndrome. Eisenmenger syndrome is a reversal of the left-to-right heart shunt. This is the result of hypertrophy of the right ventricle over time. This causes a right-to-left heart shunt. The VSD allows deoxygenated blood to flow from the right to left side of the heart. This blood bypasses the lungs. The lack of oxygenation in the pulmonary circulation results in cyanosis. Widely split fixed S2 and systolic ejection murmur at the left upper sternal border
Classic for a patent foramen ovale (PFO) or atrial septal defect (ASD). A PFO is lack of closure of the foramen ovale. At first, this produces a left-to-right heart shunt. This does not produce cyanosis, but causes pulmonary hypertension. Longstanding uncorrected atrial septal defects can also result in Eisenmenger syndrome. Eisenmenger syndrome can result in cyanosis. Management
A medical provider (e.g. doctor) may order tests for further evaluation of a heart murmur. The echocardiogram is a common test used. This is also known as an "echo" or ultrasound of the heart. It shows the heart structures and blood flow through the heart. Further testing is usually done when symptoms that may be of concern are present. The need for treatment depends on the diagnosis and severity.
Following this is a parasternal early diastolic and mid-diastolic murmur (Austin Flint murmur). The exact cause of an Austin Flint murmur is unknown. Hypothesis is that the mechanism of murmur is from the severe aortic regurgitation. In severe aortic regurgitation the jet vibrates the anterior mitral valve leaflet. This causes collision with the mitral inflow during diastole. As such, the mitral valve orifice narrows. This results in increased mitral inflow velocity. This leads to the jet impinging on the myocardial wall.Ruptured aortic sinus (sinus of Valsalva) may present as a continuous murmur. This is an uncommon cause of continuous murmur One may hear it at the aortic area and along the left sternal border. Types and disease associations
Continuous machinery murmur, at the left upper sternal border
Classic for a patent ductus arteriosus (PDA). Signs of infants associated with serious cases of PDA are poor feeding, failure to thrive and respiratory distress. Other examination findings may include widened pulse pressures and bounding pulses. Systolic murmur loudest below the left scapula
Classic for a coarctation of the aorta. Coarctation of the aorta is narrowing of the aorta. This can occur in Turners Syndrome, (gonadal dysgenesis). Turners Syndrome is an X-linked disorder with absence of one X-chromosome. Other exam findings of coarctation of the aorta include radio-femoral delay. This is when the femoral pulse is later than the radial pulse. The pulses in the lower extremity may be weaker than those of the upper extremity. Another exam finding is of varying blood pressure in the upper and lower extremities.