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