diastolic murmur

Classification

• graded I to IV

Etiology

• early diastolic murmur
  • aortic regurgitation
    • aortic root dilation
    • bicuspid aortic valve
  • pulmonic regurgitation
    • associated with repair of tetralogy of Fallot
• mid-to-late diastolic murmur
  • mitral stenosis
    • Austin-Flint murmur
  • tricuspid stenosis
  • atrial myxoma (uncommon)
  • increased flow across non-stenotic mitral valve
    • mitral regurgitation
    • ventricular septal defect
    • patent ductus arteriosus
    • high output states
    • complete heart block
  • increased flow across non-stenotic tricuspid valve
    • tricuspid regurgitation
    • anomalous pulmonary venous return

Clinical manifestations

• early diastolic murmur
  • begin immediately following S2
  • high-pitched
  • aortic regurgitation
    • increased intensity with exhalation, leaning forward
    • wide pulse pressure
  • pulmonic regurgitation
    • single S2 if repair of tetralogy of Fallot
    • increased intensity with inspiration
• mid-to-late diastolic murmur
  • low-pitched
  • heard best with bell of stethoscope

Diagnostic procedures

• transthoracic echocardiogram (all)
• transesophageal echocardiogram
  • improved imaging quality, especially for mitral valve

More general terms

• heart murmur

More specific terms

• Austin-Flint murmur/phenomenon