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
  • Palpitations
• Signs:
  • Collapsing pulse
  • Wide pulse pressure
  • Very displaced thrusting apex (volume-loaded)
  • 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
  • Fatigue
  • Haemoptysis
  • Chest pain
• Signs:
  • Malar flush (due to low cardiac output)
  • AF
  • Tapping apex (palpable S1)
  • Loud S1
  • Signs of pulmonary hypertension (RV heave, loud P2)

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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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