Heart Murmurs

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.

Mitral Stenosis

  • Mid diastolic
  • Rumbling
  • Best heads on expiration

Aortic Regurgitation

  • 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

Tricuspid Regurgitation

  • 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

Mitral Regurgitation

  • Louder in expiration (left heart)