DIASTOLIC MURMURS: occurs during resting phase

  • Occurs during refilling atria
  • Heard between S2 and S1
  • Examples:
    • Mitral stenosis (MS)
    • Aortic regurgitation (AR)
  • Early Diastolic Murmur
  • Mid Diastolic Murmur
  • Late
    • Presystolic
    • Atrial systolic
    • Begins with S2
    • Begins after S2; usually followed by opening snap or S3
    • Begins late in diastole; ends with S1

Austin Flint Murmur - Late diastolic/Presystolic

Caused by regurgitation from aorta pressing on anterior leaflet of mitral valve, partially narrowing it's flow from atria (functional mitral valve stenosis). Presystolic "atrial kick"
accentuates flow producing soft low pitched diastolic rumble best heard at apex.

TIMING OF COMMON MURMURS
Aortic Stenosis
Mitral regurgitation
Aortic regurgitation

Mitral stenosis
Mitral valve prolapse
Innocent murmur

Tricuspid stenosis
Tricuspid insufficiency		 Midsystolic; crescendo-decrescendo
Holosystolic (pansystolic)
Early diastolic; decrescendo

Mid diastolic; decrescendo
Mid to late systolic; variable configuration
Variable

Mid diastolic
Pansystolic

Having trouble remembering which murmurs are systolic and which are diastolic?

  • Think of Ms. Ard and Mr. Pass !

    Ms. Ard - Mitral stenosis (Ms), aortic regurgitation (Ar) are diastolic (d)
    Mr. Pass - Mitral regurgitation (Mr), physiologic (P) and aortic stenosis (as) are systolic (s)
MNEMONIC FOR MURMURS
 
Ms. ARD Mitral stenosis (MS) and aortic regurgitation (AR) are diastolic murmurs
   
Mr. PASS Mitral regurgitation (MR), physiologic (P) and aortic stenosis (AS) are all systolic murmurs