II. General

  1. Diastolic Murmurs are almost always pathologic

III. 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

IV. 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

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Related Studies

Ontology: Diastolic Murmurs (C0232262)

Concepts Sign or Symptom (T184)
MSH D006337
SnomedCT 163087007, 140301005, 30782001
LNC LA17240-5
Dutch diastolisch geruis
German diastolisches Geraeusch, Diastolische Geräusche, Diastolische Herzgeräusche
Italian Soffio diastolico
Portuguese Sopro diastólico
Spanish Soplo diastólico, soplo diastólico (hallazgo), soplo diastólico
Japanese 拡張期性心雑音, カクチョウキセイシンザツオン
English Diastolic Murmurs, Diastolic Murmur, Murmur, Diastolic, Murmurs, Diastolic, diastolic murmurs, diastolic heart murmur, diastolic murmur, Murmur diastolic, Diastolic heart murmur, functional murmur diastolic, Diastolic murmur (diagnosis), Murmur-diastolic, Diastolic murmur, DM - Diastolic murmur, Diastolic murmur (finding), Diastolic murmur, NOS
French Souffle diastolique, Murmure diastolique, Souffles diastoliques
Czech Diastolický šelest, diastolické šelesty
Hungarian Diasztolés zörej
Norwegian Diatolisk bilyd