Cardiac murmurs – diasystolic

Aortic regurgitation

Aortic regurgitation results in regurgitation of blood from the aorta back into the left ventricle during diastole. This results in increased left ventricular end-diastolic volume.

• Character: Early diastolic (sounds like a breath)
• Best heard: upper right sternal edge (or lower left sternal edge sitting forwards); loudest on expiration
• Radiation: none
• Symptoms:
  • Fatigue
  • SOB
• Signs:
  • Collapsing pulse
  • Wide pulse pressure
  • Displaced thrusting apex
  • Backflow signs:
    • Corrigan’s (visible carotid pulsation)
    • de Musset’s (head-nodding pulse)
    • Quincke’s (red-coloured pulsation in nails)
  • ±Austin Flint murmur (apical diastolic rumble)

Mitral stenosis

Mitral stenosis causes increased resistance between left atrium and left ventricle. This results in high left atrial pressure and subsequent pulmonary hypertension.

• Character: low rumbling mid-diastolic with opening snap
• Best heard: apex in left lateral position; loudest on expiration using bell of stethoscope
• Radiation: none
• Symptoms:
  • Dyspnoea
  • Haemoptysis
  • Chest pain
  • Fatigue
• Signs:
  • AF
  • Malar flush
  • Tapping apex
  • Loud S1
  • Signs of pulmonary hypertension (RV heave, loud P2)

Why don’t you test your knowledge?

What are the causes of a wide and narrow pulse pressure?

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What is an Austin Flint murmur?

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What are the Duke criteria for infective endocarditis?

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A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Try some OSCE stations!

1. Cardiovascular examination
2. Cardiovascular examination pansystolic murmur
3. Cardiovascular examination valve replacement
4. Aortic Stenosis
5. Chest Pain 1
6. And there’s lots more here!