conditions such as DIABETESandOBESITY(including
WEIGHT LOSS AND WEIGHT MANAGEMENT) that can lead
to cardiovascular disease.
See also CARDIOVASCULAR DISEASE PREVENTION;
MEDICATIONS TO TREAT CARDIOVASCULAR DISEASE; PHYSI-
CAL EXERCISE AND CARDIOVASCULAR HEALTH; VENTRICU-
LAR ASSIST DEVICES(VADS).
heart murmur The sound of BLOOD flowing
through an abnormal opening in the HEART. Heart
murmur is a sign rather than a condition. Tran-
sient heart murmurs are common and benign,
generally signaling an occasional or circumstantial
incomplete valve closure, and do not require fur-
ther evaluation or treatment. Transient heart mur-
murs may be present during FEVER, especially in
children, and in pregnant women. Heart murmur
sometimes occurs with noncardiovascular condi-
tions such asANEMIAand HYPERTHYROIDISM.
Murmurs are likely to herald cardiovascular
disorders when they appear with symptoms such
as shortness of breath (DYSPNEA) with exertion.
Persistent heart murmurs may indicate a heart
condition that requires treatment. The most com-
mon cardiac causes of murmur are
- VALVULAR HEART DISEASE, in which a valve in the
heart fails to close properly and blood flows
back through it - atrial septal defect or ventricular septal defect,
in which there is an opening in the septum, or
heart wall, between the two atria or the two
ventricles that allows blood to flow directly
between the affected chambers - AORTIC STENOSISor pulmonary ARTERYstenosis, in
which narrowing of the artery causes blood to
back up
Persistent heart murmurs may also be present
in GENETIC DISORDERSsuch as MARFAN SYNDROMEor
CHROMOSOMAL DISORDERSsuch as DOWN SYNDROME
(trisomy 21). These conditions often have cardio-
vascular components. The diagnostic path typi-
cally includes ELECTROCARDIOGRAM (ECG) and
ECHOCARDIOGRAM or COMPUTED TOMOGRAPHY (CT)
SCANand may include more invasive diagnostic
procedures such as CARDIAC CATHETERIZATION. Treat-
ment targets the underlying cause of the murmur
and may include medications or an OPERATIONto
repair the problem.heart murmur 59MEDICATIONS TO TREAT HEART FAILUREMedication Type Representative Medications Effects
angiotensin II receptor inhibitors losartan, valsartan, telmisartan dilate arteries; lowerBLOOD PRESSURE
angiotensin-converting enzyme captopril, enalapril, ramipril, benazepril, dilate arteries; lower blood pressure;
(ACE) inhibitors monopril slow progression ofHEART FAILURE
anticoagulants warfarin, heparin, aspirin reduce blood’s tendency to clot
beta blockers carvedilol, metoprolol, propranolol, sotalol, regulateHEART RATE
timolol
calcium channel blockers amlodipine dilate arteries; lower blood pressure
diuretics hydrochlorothiazide, furosemide, reduce fluid accumulations (edema)
bumetanide, metolazone
inotropics digoxin, digitoxin strengthen heartMUSCLE; decrease heart’s
workload
vasodilators nitroglycerin, isosorbide, hydralazine, relax and open blood vessels
minoxidil