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A continuous murmur
  1. Li Zhou1,
  2. Simone Romano2,
  3. Satish J Chacko1,
  4. Vibhav Rangarajan1,
  5. Jaehoon Chung1,
  6. Afshin Farzaneh-Far1,3
  1. 1Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  2. 2Department of Medicine, University of Verona, Verona, Italy
  3. 3Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Afshin Farzaneh-Far, Section of Cardiology, University of Illinois at Chicago, 840 South Wood St. M/C 715, Suite 920 S, Chicago, IL 60612, USA; afshin{at}

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Continuous murmurs are those that begin in systole and continue without interruption through the second heart sound, even if they do not occupy all of diastole. Important pathological causes in adults include patent ductus arteriosus, ruptured sinus of valsalva, aortic coarctation, branch pulmonary stenosis, and coronary or peripheral arteriovenous fistula.


A previously well 57-year-old-woman presented with several months of exertional dyspnoea and occasional irregular palpitations. Physical examination was notable for symmetrical pulses with a wide pulse pressure (BP=160/50), a displaced apical impulse, and a continuous murmur loudest in the second left intercostal space.

Cardiac MRI demonstrated a patent ductus arteriosus connecting the proximal left pulmonary artery to the descending aorta, distal to the left subclavian artery (figure 1A, B, arrows and see online supplementary video …

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  • Contributors LZ and SR wrote the first draft. SJC, VR and JC helped acquire and postprocess the images. AF-F supervised patient management, conducted image acquisition and conceived the manuscript.

  • Funding JC was funded by an NIH training grant-no: T32HL072742.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.