Carey Coombs murmur

Carey Coombs murmur is a clinical finding associated with rheumatic fever, characterized by a short, mid-diastolic heart murmur. This murmur is best heard at the cardiac apex, which is located at the bottom left portion of the heart. The presence of a Carey Coombs murmur is indicative of mitral valve involvement in the acute phase of rheumatic fever, specifically mitral valvulitis, which is the inflammation of the valve. This condition is most commonly seen in children and young adults following an infection by the group A streptococcus bacterium, which may also cause strep throat and scarlet fever.

Characteristics

The Carey Coombs murmur is described as a low-pitched, rumbling murmur. It occurs during the diastolic phase of the cardiac cycle, which is when the heart relaxes and fills with blood. The murmur is thought to result from increased flow across the mitral valve due to the valvulitis, which leads to the characteristic sounds. As the inflammation resolves and potential scarring of the valve occurs, the murmur may disappear or evolve into a different murmur indicative of mitral stenosis, a long-term complication of rheumatic fever.

Diagnosis

Diagnosis of a Carey Coombs murmur is primarily clinical, based on the auscultation of the heart sounds with a stethoscope. Further diagnostic tests may include an echocardiogram, which can provide detailed images of the heart's structure and function, allowing for the assessment of the mitral valve's condition and the presence of any associated abnormalities such as regurgitation or stenosis.

Treatment

Treatment of a Carey Coombs murmur involves addressing the underlying rheumatic fever, typically with antibiotics to eradicate the streptococcus bacterium, along with anti-inflammatory medications to reduce inflammation of the heart and other affected tissues. Long-term management may include secondary prevention of rheumatic fever with continuous or intermittent antibiotics to prevent recurrence, which is crucial to avoid further damage to the heart valves.

Prognosis

The prognosis for individuals with a Carey Coombs murmur is generally good if rheumatic fever is promptly treated and managed to prevent recurrence. However, complications such as mitral stenosis can develop later in life, necessitating ongoing medical surveillance and potentially surgical intervention.