From the Guidelines
A Coombs-Carey murmur is a short mid-diastolic murmur typically associated with acute rheumatic fever, characterized by inflammation of the mitral valve, and is best heard at the apex of the heart. This murmur is usually low-pitched, rumbling, and short in duration, differing from the murmur of mitral stenosis as it is temporary and resolves with treatment of the underlying rheumatic fever 1. The development of this murmur is due to the inflamed valve leaflets causing turbulent blood flow during the filling phase of the cardiac cycle.
Key Characteristics
- Mid-diastolic timing
- Low-pitched and rumbling quality
- Short duration
- Best heard at the cardiac apex
- Associated with acute rheumatic fever and mitral valvulitis
Diagnostic Considerations
The presence of a Coombs-Carey murmur serves as an important diagnostic clue for acute rheumatic fever, especially when accompanied by other Jones criteria such as polyarthritis, erythema marginatum, subcutaneous nodules, chorea, or evidence of a preceding streptococcal infection 1.
Management
Treatment focuses on managing the underlying rheumatic fever with antibiotics, anti-inflammatory medications, and supportive care, rather than addressing the murmur itself, which will resolve as the inflammation decreases 1.
Clinical Significance
It's crucial to differentiate the Coombs-Carey murmur from other heart sounds and murmurs, as it indicates a specific pathological condition that requires appropriate management to prevent long-term cardiac complications. The murmur's temporary nature and resolution with treatment underscore the importance of accurate diagnosis and timely intervention in acute rheumatic fever.
From the Research
Definition of Coombs-Carey Murmur
- A Coombs-Carey murmur is a short mid-diastolic murmur that can be heard in patients with acute rheumatic fever 2.
- It is not explicitly defined in the provided studies, but based on the context, it appears to be related to the cardiac complications of rheumatic fever.
Clinical Significance
- The presence of a Coombs-Carey murmur may indicate underlying valvular pathology, such as mitral stenosis or other cardiac lesions 3.
- Diastolic murmurs, including the Coombs-Carey murmur, can be a sign of important underlying heart disease and may require further evaluation and management 3.
Related Cardiac Conditions
- Rheumatic heart disease remains a significant cause of acquired heart disease in developing countries, and the Coombs-Carey murmur may be associated with this condition 2.
- Other cardiac conditions, such as mitral valve prolapse and regurgitation, tricuspid regurgitation, and hypertrophic cardiomyopathy, can also present with murmurs, although these may not be directly related to the Coombs-Carey murmur 3.