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BDX6 Diastolic Murmurs
Michael S. Feldman, MD, is Clinical Professor of Medicine at the University of Pennsylvania School of Medicine, and Chairman of the Graduate Education Foundation. Bernard Segal, MD, is professor of medicine at Thomas Jefferson University Hospital, and director of the Jefferson Heart Institute. In this sixth of a seven-part series, they discuss early, mid-, and late diastolic murmurs. Auscultatory examples of the most common and significant murmurs are provided. The authors note that early diastolic murmurs are caused by aortic regurgitation and pulmonary regurgitation and they describe how location can be useful in differentiating the two, and the role and causes of the so-called Austin Flint murmur in patients with isolated aortic regurgitation. The functional early diastolic murmur known as a Graham steel murmur which occurs when pulmonary hypertension results in pulmonary leaflet prolapse and pulmonary regurgitation is also reviewed. The authors go on to explain the sounds and causes of mid- and late diastolic murmurs, with mitral stenosis being the commonest cause ... and they discuss the diagnostic features of mitral stenosis, and particularly the heart sounds associated with this condition. They then cover nonstenotic mid diastolic murmurs originating in mitral and tricuspid valves. Late diastolic murmurs, although, rare, are heard in patients with mitral stenosis or myxoma of the left atrium. The lecture is accompanied by audio and visual materials. |
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