| Valvular Diseases |
| Type | Etiology | Murmur | Comments |
| Aortic stenosis | Age-related calcification in the elderly
Bicuspid aortic valve in the young
leads to early calcification of the valve
| Systolic murmur
crescendo-decrescendo murmur
radiates to the carotids
heard best at the base | Symptomssyncope
angina
dyspnea on exertion
Patients may develop arrhythmias
Pulsus parvus et tardus |
Mitral regurgitation
| Rheumatic fever
Endocarditis
Post-myocardial infarction rupture of the chordae or papillary muscles
Left ventricular dilatation | Holosystolic murmur
high-pitched and radiates towards the axilla
heard best at the apexManeuvers↑ murmur intensity
hand griprapid squatting | – |
| Tricuspid regurgitation | Right ventricular dilatationRheumatic feverEndocarditis | Holosystolic murmurheard best in the tricuspid area | Can be seen in patients with a history intravenous drug use |
| Mitral valve prolapse | Myxomatous
degeneration may be due to Marfan or Ehlers-Danlos syndrome
idiopathic over-production of dermatan sulfate
Rheumatic fever | Systolic murmur late systolic crescendo murmur with a mid-systolic click
heard best over the apex | Symptomsnonspecific and includespalpitationsdizzinessdyspneaanxiety |
| Aortic regurgitation | Aortic root dilatationBicuspid aortic valveEndocarditisRheumatic fever | Diastolic murmurearly diastolic decrescendo murmurAustin Flint murmurapical diastolic rumbling
Maneuvers↑ murmur intensity
hand griprapid squatting | When severe and chronic patients can developwide-pulse pressure
hyperdynamic pulse
head bobbing
Compensatory increases in heart rate and stroke volume to maintain cardiac output |
| Mitral stenosis | Rheumatic fever | Diastolic murmuropen snap (OS) and delayed rumbling mid-to-late diastolic murmurthe time between A2 and OS is inversely correlated with severity | Left atrium can become dilatedmay compress the esophagus and left recurrent laryngeal nerve
may result in atrial fibrillation |
