Hepatopulmonary Syndrome (HPS): This condition is characterized by a new onset heart murmur due to intrapulmonary vascular dilatations, which can occur in patients with liver cirrhosis. The murmur is often continuous and heard best at the left lower sternal border. The presence of liver cirrhosis makes HPS a highly plausible diagnosis.

Infective Endocarditis: Patients with liver cirrhosis are at increased risk of developing infective endocarditis, especially if they have a history of invasive procedures or poor dental health. The new onset heart murmur could be a sign of valve involvement.
Non-Cirrhotic Portal Hypertension: This condition can lead to the development of portosystemic shunts, which may cause a heart murmur due to increased flow through the pulmonary vasculature.
Anemia-related Cardiomyopathy: Chronic ITP can lead to anemia, which may result in a high-output state and subsequent cardiomyopathy, potentially causing a new heart murmur.

Pulmonary Embolism: Although less likely, pulmonary embolism can cause a new onset heart murmur and is a potentially life-threatening condition that requires immediate attention. The risk of pulmonary embolism may be increased in patients with chronic ITP due to splenectomy or other pro-thrombotic conditions.
Aortic Dissection: This is a rare but deadly condition that can cause a new heart murmur. Patients with liver cirrhosis may have underlying vascular abnormalities that increase their risk of aortic dissection.

Cardiac Amyloidosis: This condition can cause a restrictive cardiomyopathy and a new onset heart murmur. Although rare, it is more common in patients with chronic diseases such as liver cirrhosis.
Traumatic or Spontaneous Rupture of a Chordae Tendineae: This is a rare condition that can cause a new onset heart murmur, especially in patients with underlying cardiac disease or those taking anticoagulant medications.