Murmurs can happen from valvular problems, meaning a valve could be leaky or stenotic. It could happen from abnormal connections in the heart. It can happen from holes in the heart or shunts, it can happen from excessive blood flow. It can happen from other disease states that make the heart work harder. The other murmurs we would hear are from conditions called atrial or ventricular septal defect, hypertrophic cardiomyopathy. These are more advanced topics that we will discuss in other videos. These also cause certain characteristic systolic murmurs.