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Heart Murmurs

Heart Murmurs (Ref. Hari. 18th ed., pg -1827)
  1. Early systolic = a. VSD with PAH, b. Very small VSD c. An early systolic murmur is a feature of tricuspid regurgitation occurring in the absence of pulmonary hypertension, a lesion that is common in narcotics abusers with infective endocarditis. (Ref. Hari. 18th ed., Pg-1387)
  2. Midsystolic murmurs – (Ejection Systolic murmurs) –
    1. AS
    2. PS
  3. Late systolic murmurs –  MVPQ , Papillary muscle dysfunction. Q
  4. Pan systolic murmurs :
    1. MR Q ,
    2. TR Q,
    3. VSD Q
  5. Early diastolic murmurs :
    1. AR,
    2. PR
  6. Mid diastolic murmurs :
    1. MSQ ,
    2. TSQ ,
    3. Carey-Coombs murmur Q ,
    4. Atrial myxoma Q,
    5. Austin Flint,
    6. Graham Steel (Extra Edge: Please note that all named murmur are diastolic !!!). 
​​Carry Coombs murmur = It is a low pitch, mid or delayed diastolic murmur produce due to increase diastolic flow secondary to MR in acute rheumatic carditis.
  1. Late diastolic murmur = atrial myxoma (In this it can also be mid diastolic murmur)
  2. Continuous murmurs-
    1. PDAQ
    2. Coronary AV fistula Q
    3. Ruptured sinus of Valsalva Q
    4. ASD with MS (Lutembacher syndrome) Q
    5. Co-arctation
    6. Pulmonary embolism
    7. Systemic AV fistula
    8. Pulmonary AV fistula
  3. Changing murmurs-changes in character from moment to moment.
  4. Causes- Infective endocarditis, Atrial thrombus, Atrial myxoma
  5. Mammary souffle = Innocent continuous murmur heard over breast in pregnancy.
  6. Venous hum = heard in pregnancy, at right supra clavicular area.

Extra Edge: Congenital Heart Diseases with Cyanosis are also known as Morbus Caeruleus (LQ 2012)

Dynamic Auscultation




Effects of physiological interventions on murmurs-

  1. Respiration-
    1. Right sided murmurs/sounds –increase during inspiration except pulmonary ejection click which decrease during inspiration. Q
    2. Left sided murmurs/sounds –increase during expiration. 

Extra Edge: Pulmonary ejection click is the only right side event that increases on expiration. (MCQ) Q 

  1. Valsalva maneuver-most murmurs decrease in length and intensity except murmur of HOCM and MVP. Q
  2. Positional changes
    1. With standing most murmurs decrease except HOCM and MVP. Q
    2. With squatting most murmurs increase except HOCM and MVP.

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