Mitral regurgitation

-Mid-late systolic murmur (severe disease may lead to silent mr which is soft or no audible murmur
when left atrial and ventricular pressures equalize and there is no turbulence)

-MR can also have holosystolic murmur

-Infective endocarditis and viral myocarditis may also cause MR

Aortic Regurgitation
-Early decrescendo diastolic murmur at Left sternal border 3rd+4th ICS, patient sitting up leaning forward
and holding breath after full expiration.

-Gradually decreasing decrescendo diastolic murmur begins immediately after A2, high pitched blowing
in quality, left sternal border @ 3rd,4th ICS.

-Severe AR can lead to holodiastolic murmur.

Mitral Stenosis
-Opening snap early diastole, loud 1st heart sound mid-diastolic murmur.

-Mid-late diastolic murmur at cardiac apex; as it becomes severe diastolic murmur begins earlier and
heard soon after opening snap, and loud first heart sound may be heard.

Aortic Stenosis
Supravalvular AS- systolic murmur (midsystolic) at right 1st ICS.

-mild-early peaking systolic murmur.

-Severe – mid to late peaking.

Normal bicuspid aortic valve – Prominent ejection click followed by mid-systolic murmur best heard at
right 2nd ICS.

Mitral Valve Prolapse

-mid to late systolic murmur

-mvp resulting in regurgitation and heart failure can cause 3rd heart sound.

-mid -systolic click with late systolic murmur at apex

-non-ejection click and/or mid to late systolic murmur.

Tricuspid regurgitation
Holosystolic murmur increased with inspiration

Atrial Septal defect

Fixed splitting of s2, may also be associated with mid-systolic pulmonary flow murmur. In addition to
wide fixed splitting, ejection systolic murmur left 2nd ICS. If large ASD = mild-diastolic murmur.

HOCM- Systolic murmur at Lower Left sternal border, decrease with squatting and increase with
straining.

HCM -Crescendo- decrescendo systolic murmur at apex and left lower sternal border.

VSD
-loud holosystolic murmur most prominent at LLSB with a precordial thrill.

-holosystolic with maximal intensity over 3rd or 4th left ICS increase with squatting.

Ascending aortic aneurysm – a/w AR – diastolic murmur.

Cor pulmonale – right ventricular 3rd heart sound

Perciardial friction rub – high frequency grating or squeaking sound. Left sternal border and patient
leaning forward.

S3 – Chronic MR; Chronic AR; Heart failure,pregnancy,thyrotoxicosis, young healthy adolescents.

S3 b/c of RV Volume overload – end inspiration at left lower sternal border
S3 b/c of LV volume overload – end expiration at apex.

Mitral valve endocarditis

-Mitral valve perforation – chf and systolic murmur of mitral regurgitation.

Diastolic murmurs think of pathologic cause grade 2/6 and above.

Holosystolic murmur – at apex with sudden onset Chest pain,ST Elevation,bibasilar crackles together
think of MI with papillary muscle displacement leading to acute mitral regurgitation and pulmonary
edema.

Papillary muscle rupture – New holosystolic murmur post MI

Intraventricular septal rupture – New holosystolic murmur. (at left lower sternal
border,hypotension and pulmonary edema) and may be accompanied by thrill and less likely to radiate
to axilla.

Viral myocarditis
-holosystolic murmur secondary to dilated cardiomyopathy resulting in functional mitral regurgitation.

Infective endocarditis can cause MR

Right ventricular Outflow tract obstruction

Crescendo-decrescendo systolic ejection murmur (single heart sound, normal aortic and inaudible
pulmonary component(P2) of S2)

Holosystolic
VSD,IV Septal rupture,Papillary muscle rupture,Tricuspid regurgitation,viral myocarditis,MR.

NO COPYRIGHT INFRINGEMENT INTENDED, SOLELY MY NOTES A COMPILATION

OF ALL MURMUR DESCRIPTION FROM USMLE WORD STEP 2 CK 2018.