1. Diastolic Murmurs Chapter 16 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS

2. Outline Chronic Severe Aortic Regurgitation Acute Severe AR Pulmonary Regurgitation Tricuspid Stenosis

3. 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

6. 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)

7. Acute Severe AR Caused by infective endcarditis affecting the aortic valve or by dissecting aneurysm of the aortic root

10. To-and-Fro Murmur (Aortic Stenosis + AR) Aortic Valve is both stenotic and incompetent

11. 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

12. Pulmonary Regurgitation Secondary to severe pulmonary hypertension & dilatation of the pulmonary artery Exist without pulmonary hypertension or as a congenital anomaly Bacterial Endocarditis

14. Tricuspid Stenosis

15. THE END OF CHAPTER 16 Tilkian, Ara MD Understanding Heart Sounds and Murmurs, Fourth Edition, W.B. Sunders Company. 2002, pp. 197-216