Aortic causes
Left ventricular ejection murmurs are maximal at the aortic area, lower left sternal edge and apex. Possible causes include:
- aortic stenosis (valvar, subvalvular, supravalvular)
- hypertrophic obstructive cardiomyopathy
- increased stroke volume e.g. ASD
- aortic cusp sclerosis
- bicuspid aortic valve with no obstruction
- coarctation of the aorta – a coarctation murmur, when heard anteriorly, can be confused with an ejection murmur
- post-valvular dilation e.g aortic aneurysm, hypertension
An ejection systolic murmur may occur in aortic regurgitation due to increased blood flow.
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