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Heart Murmurs: Congenital Heart Defect–Associated 1227.e1

Heart Murmurs: Congenital Heart Defect–Associated
VetBooks.ir Abnormality Timing of Murmur Quality of Murmur Point of Maximal Intensity Comments

Aortic insufficiency Diastolic Decrescendo; usually soft Left base May occur in association with
a VSD; best ausculted with the
patient in left lateral recumbency
and the stethoscope under the
patient, over the left heart base
Atrial septal defect Systolic Soft Left base Result of relative pulmonic stenosis
Eisenmenger’s syndrome Absent (a systolic murmur — Left axillary region for a Split second heart sound may be
(right-to-left shunting PDA may still be present in a PDA bidirectional PDA present
or VSD) with bidirectional shunting)
Mitral dysplasia Systolic Holosystolic or pansystolic; Left apex May radiate widely
plateau
Left-to-right shunting PDA Continuous Wind tunnel, machinery Cranial to the left base Peaks in intensity at S 2
Pulmonic stenosis Systolic Crescendo-decrescendo Left base Possible ejection sound
Subaortic stenosis Systolic Crescendo-decrescendo Left base (occasionally right base May radiate up into carotid arteries
and occasionally apex)
Tetralogy of Fallot Systolic Crescendo-decrescendo Left base, right apex, or both Murmur
PMI depends on relative
contributions of pulmonic stenosis
and ventricular septal defects and
specifically on pressure gradients
associated with each Differentials, Lists, and Mnemonics
Tricuspid dysplasia Systolic Holosystolic or pansystolic; Right apex May be soft or absent in cats with
plateau severe disease
VSD Systolic Holosystolic or pansystolic; Cranial to or at right apex; left Second heart sound may be split
plateau base
VSD and aortic regurgitation Systolic and diastolic Pansystolic murmur Left base or cranial to right apex May sound as if it is continuous
(to-and-fro murmur) followed by a diastolic and may be confused with a
decrescendo murmur PDA murmur; a short pause
between the systolic and diastolic
components distinguishes it from
the continuous murmur of PDA
PDA, Patent ductus arteriosus; VSD, ventricular septal defect.
Modified with permission from Kittleson M, Kienle RD: Small animal cardiovascular medicine, St. Louis, 1998, Mosby, p 197.

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