Types[edit]

 Early diastolic murmurs start at the same time as S2 with the close of the semilunar (aortic &
pulmonary) valves and typically end before S1. Common causes include aortic or pulmonary
regurgitation and left anterior descending artery stenosis.
 Mid-diastolic murmurs start after S2 and end before S1. They are due to turbulent flow across
the atrioventricular (mitral & tricuspid) valves during the rapid filling phase from mitral or tricuspid
stenosis.
 Late diastolic (presystolic) murmurs start after S2 and extend up to S1 and have a crescendo
configuration. They can be associated with AV valve narrowing.[4] They include mitral
stenosis, tricuspid stenosis, myxoma, and complete heart block.

Individual murmurs[edit]
Early diastolic[edit]
Time Condition Description

The murmur is low intensity, high-pitched, best heard over the left
sternal border or over the right second intercostal space, especially if
the patient leans forward and holds breath in full expiration. The
Early Aortic radiation is typically toward the apex. The configuration is usually
diastolic regurgitation decrescendo and has a blowing character. The presence of this
murmur is a good positive predictor for AR and the absence of this
murmur strongly suggests the absence of AR. An Austin Flint murmur
is usually associated with significant aortic regurgitation.

Pulmonary regurgitation is most commonly due to pulmonary

hypertension (Graham-Steell murmur). It is a high-pitched and
Early Pulmonary
blowing murmur with a decrescendo configuration. It may increase in
diastolic regurgitation
intensity during inspiration and best heard over left second and third
intercostal spaces. The murmur usually does not extend to S1.

Left anterior This murmur, also known as Dock's murmur, is similar to that of aortic
Early
descending regurgitation and is heard at the left second or third intercostal space.
diastolic
arterystenosis A Coronary artery bypass surgery can eliminate the murmur.

This murmur sounds similar to aortic insufficiency, but does not have
Early Cabot–Locke
a decrescendo. It is often heard in untreated anemia, and is best
diastolic murmur
heard at the left sternal border.

Mid-diastolic[edit]
 Time Condition Description

This murmur has a rumbling character and is best heard with the
bell of the stethoscope in the left ventricular impulse area with the
patient in the lateral decubitus position. It usually starts with an
opening snap. In general, the shorter the duration (S2 to Opening
Mid-
Mitral stenosis Snap), the more severe the mitral stenosis. However, this rule can
diastolic
be misleading in situations where the stenosis is so severe that the
flow becomes reduced, or during high-output situations such as
pregnancy where a less severe stenosis may still produce a strong
murmur. In mitral stenosis, tapping apical impulse is present.

Best heard over the left sternal border with rumbling character and
tricuspid opening snap with wide splitting S1. May increase in
Mid-
Tricuspid stenosis intensity with inspiration (Carvallo's sign). Tricuspid stenosis often
diastolic
occurs in association with mitral stenosis. Isolated TS are often
associated with carcinoid disease and right atrial myxoma.

Atrial myxomas are benign tumors of the heart. Left myxomas are
Mid- far more common than right myxomas and those may cause
Atrial myxoma
diastolic obstruction of the mitral valve producing a mid-diastolic murmur
similar to that of mitral stenosis.

Increased flow
This can also produce a mid-diastolic murmur, such as in severe
Mid- across the
mitral regurgitation where a large regurgitant volume in the left
diastolic atrioventricular
atrium can lead to "functional mitral stenosis."
valve

An apical diastolic rumbling murmur in patients with pure aortic

Mid- regurgitation. This can be mistaken with the murmur in mitral
Austin Flint murmur
diastolic stenosis because an Austin Flint murmur does not have an opening
snap that is found in mitral stenosis.

Mid- Carey-Coombs A mid-diastolic murmur over the left ventricular impulse due to
diastolic murmur mitral valvulitis from acute rheumatic fever.
Late diastolic[edit]
Time Condition Description

Late diastolic Complete heart A short late diastolic murmur can occasionally be heard
(presystolic) block (Rytand's murmur).