From the Research
The murmur of anemia can indeed be enhanced with certain maneuvers, specifically having the patient perform a Valsalva maneuver typically decreases the intensity of the anemic murmur, while having the patient squat or perform passive leg raising tends to increase its intensity, as supported by the pathophysiological understanding of anemia's effects on the heart and blood vessels 1. The changes in murmur intensity with different maneuvers occur because anemic murmurs are flow murmurs caused by increased cardiac output and blood flow velocity across the heart valves due to decreased blood viscosity in anemia.
- The murmur is typically a soft, systolic ejection murmur best heard at the left sternal border or apex.
- Maneuvers that increase venous return to the heart (like squatting) enhance the murmur by increasing cardiac output, while maneuvers that decrease venous return (like Valsalva) diminish it. Understanding these characteristics helps differentiate anemic murmurs from other cardiac murmurs during physical examination, which is important for proper diagnosis and management of patients with anemia, ultimately impacting morbidity, mortality, and quality of life 2. Key points to consider in the management of anemia include the replenishment of iron stores and the return of hemoglobin to a normal level, which has been shown to improve quality of life, morbidity, prognosis in chronic disease, and outcomes in pregnancy 2.
- The most recent and highest quality study 2 emphasizes the importance of diagnosing and managing iron deficiency anemia, highlighting its prevalence and impact on various patient populations.
- The study also discusses the benefits and limitations of oral versus intravenous iron replacement, providing an overview on cost analysis between different iron formulations currently on the market 2.