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diastolic murmur

Classification: - graded I to IV Etiology: 1) early diastolic murmur a) aortic regurgitation - aortic root dilation - bicuspid aortic valve b) pulmonic regurgitation - associated with repair of tetralogy of Fallot 2) mid-to-late diastolic murmur a) mitral stenosis - Austin-Flint murmur b) tricuspid stenosis c) atrial myxoma (uncommon) d) increased flow across non-stenotic mitral valve 1] mitral regurgitation 2] ventricular septal defect 3] patent ductus arteriosus 4] high output states 5] complete heart block e) increased flow across non-stenotic tricuspid valve 1] tricuspid regurgitation 2] anomalous pulmonary venous return Clinical manifestations: 1) early diastolic murmur a) begin immediately following S2 b) high-pitched c) aortic regurgitation - increased intensity with exhalation, leaning forward - wide pulse pressure d) pulmonic regurgitation - single S2 if repair of tetralogy of Fallot - increased intensity with inspiration 2) mid-to-late diastolic murmur a) low-pitched b) heard best with bell of stethoscope Special laboratory: 1) transthoracic echocardiogram (all) [3] 2) transesophageal echocardiogram - improved imaging quality, especially for mitral valve

Specific

Austin-Flint murmur/phenomenon

General

heart murmur

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 327-28
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 199
  3. Medical Knowledge Self Assessment Program (MKSAP) 14, 17. American College of Physicians, Philadelphia 2006, 2015
  4. What Is a Heart Murmur? http://www.nhlbi.nih.gov/health/dci/Diseases/heartmurmur/hmurmur_what.html

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