Over of a period of 5–50 years, significant murmurs indicate valve disease that increase the work of the heart

muscle and cause it to enlarge. The muscle finally becomes weak and heart failure occurs (see the chapter Heart Failure). Some murmurs such as that caused by mitral stenosis prevent the chambers of the heart from filling.

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• I. CLINICAL CASES A. Questions Posed
  A female, age 30, posed the following questions: My family doctor says that I have a systolic murmur at the apex of the heart and referred me to a cardiologist. I would like to know:
• II. CLINICAL DIAGNOSIS OF HEART MURMURS
  A. Diagnostic Clues
• III. INVESTIGATIVE TESTS
  Chest x-ray, ECG, and echocardiogram are helpful to confirm the clinical opinion obtained from the patient’s history and relevant examination. In a few individuals with serious heart murmurs causing symptoms such as severe shortness of breath with or without heart failure, cardiac catheterization tests are invaluable to corroborate the findings on echocardiography. This is often done if surgical correction is planned. The technique of catheterization is outlined in the chapter Tests for Heart Diseases, and echocardiographic diagnostic points are given in the chapter Valve Diseases.
• BIBLIOGRAPHY
  Khan, M. Gabriel. On Call Cardiology, second edition. W. B. Saunders, Philadelphia, 2001.