Exam

Diastolic Murmur

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Diastolic Murmur

  • See Also
  1. Heart Murmur
  2. Systolic Murmur
  3. Pediatric Murmur
  • General
  1. Diastolic Murmurs are almost always pathologic
  • Causes
  1. Early, Diastolic Regurgitation Murmur
    1. Aortic Regurgitation
      1. Murmur 1-2/6 high pitch, decrescendo, left third intercostal, best at end-expiration, sitting, leaning forward
    2. Pulmonic Regurgitation
      1. Murmur 1-2/6 high pitch, decrescendo, left upper sternal border, best with inspiration
  2. Early, Diastolic Ejection Murmur
    1. Mitral Stenosis (<1 per 10,000 live births)
      1. Murmur 1-2/6 at apex
  3. Diastolic To-and-fro Murmur
    1. Patent Ductus Arteriosus (newborns, 5 per 10,000 births)
      1. Murmur 2-4/6 at left upper sternal border, machinery sound (to and fro), also heard as Systolic Murmur
  • Exam
  1. See Heart Murmur
  2. Dynamic Maneuvers
    1. Increased Afterload (e.g. hand grip, transient arterial Occlusion with Blood Pressure cuff)
      1. Increases Aortic Regurgitation, Ventricular Septal Defect (and possibly Mitral Stenosis) Diastolic Murmurs
    2. Increased venous return and increased left Ventricular Afterload (e.g. deep or exaggerated inspiration)
      1. Increases tricuspid stenosis (and possibly pulmonary regurgitation) Diastolic Murmurs
    3. Decreased jugular venous return (Jugular Vein compression, or transition supine from sitting)
      1. Decreases Venous Hum continuous murmur
  • References
  1. Ford (2022) Am Fam Physician 105(3): 250-61 [PubMed]