Diastolic Murmurs Chapter 16

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Diastolic MurmursChapter 16

• Are G. Talking, MD, FACC
• Instructor
• Patricia L. Thomas, MBA, RCIS

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Outline

• Chronic Severe Aortic Regurgitation
• Acute Severe AR
• Pulmonary Regurgitation
• Tricuspid Stenosis

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Introduction

• Diastolic Regurgitant Murmurs result from
  retrograde flow across incompetent semilunar
  valves
• Diastolic filling murmurs results from forward
  flow across stenotic or obstructed AV valves
• Early-Diastolic murmurs are decrescendo usually
  the result of AR or PR
• Mid-Diastolic Murmurs are diamond shaped
  characteristic of narrowed mitral or tricuspid
  valves or increased flow rate across the valves
• Late-Diastolic Murmurs are crescendo caused by
  obstruction of the inflow of either ventricle
  mitral or tricuspid stenosis

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Chronic Severe AR

• Caused by rheumatic fever or congenital
  abnormalities of the aortic valve
• Pandiastolic
• Aortic Systolic Ejection Murmur
• To-and-Fro Murmur AS AR
• Austin Flint Murmur (Rumble)

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Acute Severe AR

• Caused by infective endcarditis affecting the
  aortic valve or by dissecting aneurysm of the
  aortic root

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To-and-Fro Murmur (Aortic Stenosis AR)

• Aortic Valve is both stenotic and incompetent

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Austin Flint Murmur (Rumble)

• Austin Flint heard the murmur 1859
• Blubbering Sound
• Caused by the collision of the regurgitant aortic
  jet with the anterior leaflet of the MV
  distorting its shape causing the leaflet to
  shudder

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Pulmonary Regurgitation

• Secondary to severe pulmonary hypertension
  dilatation of the pulmonary artery
• Exist without pulmonary hypertension or as a
  congenital anomaly
• Bacterial Endocarditis

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Tricuspid Stenosis
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THE END OF CHAPTER 16

• Tilkian, Ara MD Understanding Heart Sounds and
  Murmurs,
• Fourth Edition, W.B. Sunders Company. 2002, pp.
  197-216