DIASTOLIC MURMURS

Question 1

name them?

Answer 1

aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis
Austin flint murmur

Question 2

Best heard with diaphragm over left sternal border or over the right second interspace, while the
patient sits and leans forward with the breath held in full expiration; radiation toward cardiac apex
Usually early diastolic decrescendo, duration variable, usually terminates before S1; high-frequency,
blowing character

• Associated with wide pulse pressure -> water-hammer pulse, head bob with each heartbeat (Musset’s
  sign) , capillary pulsations in fingertips or lips (Quincke’s pulses)

Answer 2

*Aortic regurgitation

Question 3

Decrescendo, high-pitched, and blowing; best heard over left 2nd and 3rd interspaces; begins with an
accentuated P2 of S2 and can be of variable duration; murmur associated with PH

Answer 3

Pulmonic regurgitation

Question 4

Mid- or late-diastolic murmur; decrescendo; low-pitched, rumbling, best heard with the bell of the
stethoscope over the left ventricular impulse (left 5th interspace) with the patient in the left lateral decubitus position; characteristically starts with opening snap

Murmur may be brief duration or even absent (so-called “silent mitral stenosis”), even in the presence
of severe MS, when flow across the mitral valve markedly reduced; this may occur in the setting of rightsided
heart failure and PH

Answer 4

Mitral stenosis

Question 5

Mid-to late diastolic rumble; best heard along the left lower sternal border

During inspiration, increased right atrial volume is associated with more forceful right atrial contraction -
> increased pressure gradient during this interval -> accentuation of the murmur (Carvallo’s sign. aka
Rivero-Carvallo’s sign)

Answer 5

Tricuspid stenosis

Question 6

Apical diastolic rumbling murmur described in patients with pure aortic regurgitation

Answer 6

Austin Flint murmur