Murmurs - Diastolic
Murmurs - Diastolic: Excerpt from In a Page: Signs and Symptoms
Diastolic heart murmurs are never normal and should always be further evaluated, in contrast to systolic murmurs, which are commonly benign or due to rapid flow rates. The part of the cardiac cycle that the murmur falls into (e.g. early, middle, or late) will help determine the etiology, as will the characteristics of the heart sounds and whether an opening snap is present.
Differential Diagnosis
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Aortic insufficiency
–Decrescendo murmur heard best at the right second intercostal space -
Austin Flint murmur
–Late diastolic rumble of severe aortic regurgitation
–A result of aortic regurgitation so severe that it causes diastolic mitral regurgitation -
Mitral stenosis
–Opening snap with mid-diastolic rumble, especially in the left lateral decubitus position -
Pulmonary insufficiency
–Accentuated P2 and decrescendo murmur at the left second/third intercostal spaces -
Tricuspid stenosis
–Mid-diastolic rumble at the left sternal
border
–Increases with inspiration
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Cervical venous hum (disappears upon pressure to the jugular vein)
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Hepatic venous hum (disappears with epigastric pressure)
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Mammary souffle (in pregnancy; disappears on compressing breast)
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PDA (continuous machinery sound)
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Coronary or pulmonary arteriovenous fistula
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Coarctation of the aorta
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ASD with left-to-right shunt
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Atrial myxoma (“tumor plop”)
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Pericardial knock (constrictive pericarditis)
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Bronchial collaterals (congenital heart disease)
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Anomalous pulmonary venous drainage with left-to-right shunt
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Pulmonary artery branch stenosis
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Carey-Coombs murmur (mid-diastolic murmur that occurs in acute rheumatic fever)
Workup and Diagnosis
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Complete history and physical examination, including cardiac maneuvers
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ECG
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Echocardiogram
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Consider chest X-ray
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Laboratory studies may include CBC, electrolytes, glucose, BUN/creatinine, TSH, liver function tests, pulse oximetry, and/or arterial blood gas
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Consider cardiology consult
Treatment
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Attention to hemodynamic status
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Treat the underlying cause (e.g., anemia, infection, hyperthyroidism, MI)
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Serial examinations to track progression of underlying cause
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Valve repair or replacement may be indicated for severe valvular disease
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Murmurs - Systolic (In a Page: Signs and Symptoms)
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