Page 107 - Clinical Pearls in Cardiology
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Auscultation of the Precordium 95
from its site of origin. If a murmur is heard with reduced
intensity at a distant location, then the murmur is said
to have radiation to that location from its site of origin.
17. What are the common causes of mid-diastolic
murmurs in apical area?
Mid-diastolic murmurs in the apical area result from
obstruction and/or augmented flow at the level of the
mitral valve. The important causes of mid-diastolic
murmur in the apical area are the following:
• Mitral stenosis
• Left atrial myxoma—duration and intensity of the
murmur varies with change in body position
• Chronic severe aortic regurgitation (Austin Flint
murmur)—due to the turbulence at the mitral valve
area from the admixture of regurgitant and forward
jets of blood
• Acute rheumatic fever (Carey–Coombs murmur)—
due to augmented blood flow through an edematous
mitral valve
• Functional mid-diastolic flow murmurs—due to
increased blood flow in severe mitral regurgitation,
large VSD, PDA, etc.
Complete heart block, with dyssynchronous atrial
and ventricular activity, may be associated with
intermittent mid to late diastolic murmurs, if atrial
contraction occurs when the mitral valve is partially
closed.
18. What are the common causes of holosystolic murmurs
in apical area?
Holosystolic murmurs begin with S1 and continue
through systole to S2. The three important causes of
holosystolic murmurs in the apical area are the following:
