The Sound of the Heart

t has long been known that patients with anemia often have cardiac murmurs, especially “innocent” or “flow” systolic murmurs. These murmurs are not related to valvular disease; they are, however, related to alterations of cardiac dynamics. Tachycardia, increased cardiac output, and dilatation of the heart result from a significant drop of the hemoglobin level. Thus, the myocardium is stressed by an increased work load while its oxygen supply may be decreased. Diffuse areas of myocardial necrosis ( mainly in the subendocardial myocardium of the left ventricle and of the papillary muscles ) in young patients who had suffered from severe GI bleeding, have been reported.’ This points out that, in addition to dynamic phenomena, myocardial lesions may be responsible for murmurs. Two types of murmurs have been reported in anemia. The most common is an ejection systolic murmur but a 1)ansystolic murmur, not influenced by posture, was also found in 21.1 percent of a series of 46 anemic Patients. 2 \Ve have reviewed the documents of anemic