Left heart lesions (aortic and mitral) louder in EXPIRATION.
Right heart lesions (pulmonary and tricuspid) are louder in INSPIRATION (aide memoiraire = it’s RIGHT to be INSPIRATIONAL!)
In diastole the mitral and tricuspid valves are open, in systole the aortic and pulmonary valves are open.
- Mid diastolic
- Best heads on expiration
- Austin Flint (functional mid diastolic murmur – the Regurgitation jet interferes with mitral valve opening / causes premature closing which can be mistaken for mitral stenosis)
- Corrigan’s Sign- rapid distension and collapse of arteries
- collapsing pulse
- Duroziez’s Sign – diastolic murmur heard over femoral when it’s compressed sigh bell of stethoscope
- Louder in inspiration (right heart) this is called Cavallo’s sign
- Lower left sternal boarder
- JVP is raised (the JVP is evidence of raised pressure in the right heart / right heart failure causing back pressure in the SVC and jugular veins) with giant v waves
- Cause is usually dilation of valve ring due to dilation of the ventricle which is caused by ventricular failure secondary to – mitral valve disease (mitral stenosis causes increased pressure in pulmonary vein) or – cor pulmonale or – primarily pulmonary hypertension
- Louder in expiration (left heart)