i)MS Murmur
Characteristic: Low pitched, rumbling inid diastolic murmur, loudest at apex with patient in left lateral decubitus, with pre systolic crescendo due to atrial contraction at the end of diastole.Increasing flow across the mitral valve as by handgrip exercise, squatting,arnyl nitrite inhalation makes the inurinur louder, Low flow across the mitral valve makes the murmur softer.Mitral diastolic inflow murmur is a low pitched rumble heard over apex and generated due to excessive flow via a normal mitral valve as in severe MR, large left to right shunts (PDA, VSD). It doesn't have presystolic accentuation and isn't preceded with an 0s. Carey Coombs.murmur is a diastolic inflow murmur heard in patients with MR with acute Rheumatic fever.
Characteristic: Low pitched, rumbling inid diastolic murmur, loudest at apex with patient in left lateral decubitus, with pre systolic crescendo due to atrial contraction at the end of diastole.Increasing flow across the mitral valve as by handgrip exercise, squatting,arnyl nitrite inhalation makes the inurinur louder, Low flow across the mitral valve makes the murmur softer.Mitral diastolic inflow murmur is a low pitched rumble heard over apex and generated due to excessive flow via a normal mitral valve as in severe MR, large left to right shunts (PDA, VSD). It doesn't have presystolic accentuation and isn't preceded with an 0s. Carey Coombs.murmur is a diastolic inflow murmur heard in patients with MR with acute Rheumatic fever.
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| Murmur of mitralstenosis in various clinical situations |
ii)TS Murmur
Characteristic: It is a rumbling, inid diastolic nlurinur heard at left lower sternal border that increases with inspiration. An OS may be audible before the murmur and it increases in intensity with inspiration as well.The murmur is softer, higher pitched and of shorter duration than MS murmur.
iii) Aortic Regurgitation'Murmur
Chronic AR Murrrzirr
Characteristic: High pitched, decrescendo inunnur, ilninediately after S2 and extending througl~ a part or all of diastole. Best heard with patient sitting up and leaning forward and at the level of left third and fourth intercostal space.Manoeuvres to increase peripheral vascular resistance such as squatting, hand grip exercise, drugs such as pl~enylephrine make the murmur of AR louder.
Characteristic: It is a rumbling, inid diastolic nlurinur heard at left lower sternal border that increases with inspiration. An OS may be audible before the murmur and it increases in intensity with inspiration as well.The murmur is softer, higher pitched and of shorter duration than MS murmur.
iii) Aortic Regurgitation'Murmur
Chronic AR Murrrzirr
Characteristic: High pitched, decrescendo inunnur, ilninediately after S2 and extending througl~ a part or all of diastole. Best heard with patient sitting up and leaning forward and at the level of left third and fourth intercostal space.Manoeuvres to increase peripheral vascular resistance such as squatting, hand grip exercise, drugs such as pl~enylephrine make the murmur of AR louder.
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| Murmurs |
Austin Flint Murmur
The AR jet may iinpinge on the undersurface of the anterior leaflet of the initral valve and push it up, thus creating a relative MS. This produces an apical diastolic rumble mimicking MS murmur. This murmur can be differentiated from MS murmur as it is not preceded with an OS and has no presystolic accentuation. Ainyl nitrite inhalation, by reducing the peripheral vascular resistance and increasing the peripheral runoff inakes the Austin Flint Murmur softer unlike nlurinur of MS, which becomes louder.
Acute AR Murmur
Characteristic: Relatively low pitched, decrescendo diastolic murmur, which may end part way through diastole. These murmurs are often described as musical or"dove-coo', These murmurs are often best heard in the 4th right intercostal space.They are almost always associated with Austin Flint Mul~nur.
iv) PR Murmur
Characteristic: Blowing, decrescendo murmur heard loudest in 2nd and 3rd left intercostal space with increase in intensity during inspiration.
V) Graham Steel Murmur
PR murmur secondary to pulmonary hypertension.
Acute AR Murmur
Characteristic: Relatively low pitched, decrescendo diastolic murmur, which may end part way through diastole. These murmurs are often described as musical or"dove-coo', These murmurs are often best heard in the 4th right intercostal space.They are almost always associated with Austin Flint Mul~nur.
iv) PR Murmur
Characteristic: Blowing, decrescendo murmur heard loudest in 2nd and 3rd left intercostal space with increase in intensity during inspiration.
V) Graham Steel Murmur
PR murmur secondary to pulmonary hypertension.
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