Ejektionsmurmur

Ejektionsmurmur, or ejection murmur, is a benign systolic heart murmur commonly heard in children and young adults. It results from normal, high-velocity flow across the semilunar valves (aortic or pulmonic) and is not associated with structural heart disease.

Clinical features include a soft (grade I–II), short systolic murmur heard best at the base of the heart, often along the left upper sternal border. It may be accentuated by increased flow, such as during inspiration, fever, or exertion, and it typically lacks accompanying abnormal findings on auscultation or symptoms of cardiac disease. The murmur does not usually radiate widely and is distinguishable from pathologic murmurs by its timing and the overall normal exam.

Pathophysiology involves increased cardiac output leading to turbulent flow across a normal outflow tract during systole. Periods of rapid growth in adolescents, athletic training, fever, or pregnancy can transiently raise flow and make the murmur more noticeable.

Differential diagnosis focuses on differentiating from pathological murmurs caused by valve stenosis, regurgitation, or septal defects. A normal growth and development, absence of heart failure symptoms, and a normal cardiovascular exam support the benign nature of the murmur. If there are red flags such as dyspnea, syncope, poor weight gain, abnormal S2, or family history of congenital heart disease, further evaluation with echocardiography may be indicated.

Prognosis is excellent. Ejektionsmurmur is benign and typically requires no treatment beyond reassurance and routine follow-up.