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Timing

Timing

Mid systolic (Ejection)

Position where murmur is best heard

Lesion

Maneuvours to accentuate murmur

Aortic area, clavicles & carotids, also apex

Aortic Stenosis

Squatting. Leg raise. Sitting in full Exp

Left Sternal Edge (3-4th IC spaces)


Lower LSE (4-5th IC spaces) & apex

Pulmonary Stenosis
Atrial Septal Defect
Hypertrophic Cardiomyopathy

Inspiration
Accentuated on Standing. Valsalva

Atrial Septal Defect

Systolic
Late Systolic

Pansystolic

Aortic or Pulmonary areas

Anaemia, Thyrotoxicosis, Pregnancy

Lower LSE & apex

Hypertrophic Cardiomyopathy

Accentuated on Standing. Valsalva

Apex

Mitrial Valve Prolapse

Earlier & louder with Valsalva

Left Sternal edge

Coarctation of the Aorta

Apex to Axilla

Mitrial Regurg (blowing, high freq)

Left Sternal edge

Tricuspid Regurg (low pitched)

Squatting, leg raise, hand grip

Ventricular Septal Defect


Early Diastolic

LSE (3-4th IC spaces) & Apex

Aortic Regurg (blowing, high pitched)

Sitting forward in full expiration

Right (or Left) Sternal edge

Pulmonary Regurg

Inspiration

Apex

Mitral Stenosis (low freq, rumbling)

Left lateral position

Murmur
Diastolic

Mid Diastolic

Austin Flint (aortic regurg)


Left Sternal edge

Tricuspid Stenosis

Late Diastolic

Apex

Mitral Stenosis

(Presystolic)

Left Sternal edge

Tricuspid Stenosis

Left lateral position

Atrial Myxoma
Left 1st or 2nd IC space Midclav line

Patent Ductus Arteriosis


A V Fistula

Continuous

Entire Cardiac Cycle

Aorto-pulmonary Fistula
Venous Hum in Children

Bell (Low pitched)

Diaphragm (High pitched

Mitral stenosis

Aortic regurg

Austin Flint

Mitral valve prolapse

Tricuspid stenosis

Pulmonary regurg

Decreased by occluding vein or by


lying child flat

Remember R.I.L.E