Valvular Disorders, Congenital Heart Defects: Murmur Timing & Maneuvers

Aortic stenosis

Early systolic crescendo-decrescendo murmur at LLSB radiating to carotids

Mitral regurgitation

Holosystolic murmur at apex radiating to axilla

Mitral valve prolapse

Mid‐systolic click followed by late systolic murmur at apex

Aortic regurgitation

Soft S1, blowing decrescendo early diastolic murmur at L 3rd ICS

Mitral stenosis

Diastolic rumble with opening snap after S2 at apex

Tricuspid regurgitation

Holosystolic murmur at LLSB that ↑ with inspiration

aortic stenosis murmur intensity ...

↑ with venous return

Mitral regurgitation murmur intensity ...

↓ with decreased venous return

Mitral valve prolapse click ...

delayed by increasing venous return

Aortic regurgitation murmur intensity ...

↑ with leaning forward, decreased venous return

Mitral stenosis murmur intensity ...

↑ with decreased venous return

Tricuspid regurgitation murmur intensity ...

↑ with increased venous return

What are some methods to increase venous return?

Passive leg raise, isometric handgrip, squatting, and inhalation.

What are some methods to decrease venous return?

Valsalva maneuver, sudden standing, and exhalation.

atrial septal defect (ASD)

Fixed, widely split S2 + mid-diastolic rumble at LLSB; no change w/ maneuvers

ventricular septal defect (VSD)

Harsh holosystolic murmur at LLSB + thrill; loudest with increased venous return

patent ductus arteriosus (PDA)

Continuous "machine-like" murmur at left infraclavicular area

Tetralogy of Fallot (TOF)

Harsh systolic ejection murmur at LUSB that ↑ with decreased venous return

coarctation of the aorta (CoA)

Systolic murmur heard between scapulae on back + UE hypertension with weak LE pulses

Transposition of the Great Arteries (TGA)

Single loud S2 + severe cyanosis at birth with minimal murmur