Editing Heart murmur (section)

=== Anatomic sources ===
====Systolic====

{{Main|Systolic heart murmur}}

*[[Aortic valve stenosis]] is a crescendo/decrescendo systolic murmur. It is best heard at the right upper sternal border (aortic area). It sometimes radiates to the carotid arteries. In mild aortic stenosis, the crescendo-decrescendo is early peaking. Whereas in severe aortic stenosis, the crescendo is late-peaking. In severe cases, obliteration of the S2 heart sound may occur.
*[[Aortic valve stenosis|Stenosis]] of [[Bicuspid aortic valve]] is like the aortic valve stenosis heart murmur. But, one may hear a systolic ejection click after S1 in calcified bicuspid aortic valves. Symptoms tend to present between 40 and 70 years of age.
*[[Mitral regurgitation]] is a [[holosystolic murmur]]. One can best hear it at the apex location and it may radiate to the axilla or precordium. When associated with [[mitral valve prolapse]], one may hear a systolic click. In this scenario, valsalva maneuver will decrease left ventricular preload. This will move the murmur onset closer to S1. Isometric handgrip will increase left ventricular afterload. This will increase murmur intensity. In acute severe mitral regurgitation, one may not hear a holosystolic murmur.
*[[Pulmonary valve stenosis]] is a crescendo-decrescendo systolic murmur. One can hear it best at the left upper sternal border. It has association with a systolic ejection click that increases with inspiration. This finding results from an increased venous return to the right side of the heart. Pulmonary stenosis sometimes radiates to the left clavicle.
*[[Tricuspid insufficiency|Tricuspid valve regurgitation]] is a holosystolic murmur. It presents at the left lower sternal border with radiation to the left upper sternal border. One may see prominent v and c waves in the JVP (jugular venous pressure). The murmur will increase with inspiration.
*[[Hypertrophic obstructive cardiomyopathy]] (or hypertrophic subaortic stenosis) will be a systolic crescendo-decrescendo murmur. One can best hear it at the left lower sternal border. Valsalva maneuver will increase the intensity of the murmur. Going from squatting to standing will also increase the intensity of the murmur.
*[[Atrial septal defect]] will present with a systolic crescendo-decrescendo murmur. It is best heard at the left upper sternal border. This is the result of an increased volume going through the pulmonary valve. It has association with a fixed, split S2 and a right ventricular heave.
*[[Ventricular septal defect]] (VSD) will present as a holosystolic murmur. One can hear it at the left lower sternal border. It has association with a palpable thrill, and increases with isometric handgrip. A right to left shunt ([[Eisenmenger syndrome]]) may develop with uncorrected VSDs. This is due to worsening [[pulmonary hypertension]]. Pulmonary hypertension will increase the murmur intensity and may present with cyanosis.
*[[Functional murmur|Flow murmur]] presents at the right upper sternal border. It may present in certain conditions, such as anemia, hyperthyroidism, fever, and pregnancy.

====Diastolic====

{{Main|Diastolic heart murmur}}

*[[Aortic valve regurgitation]] will present as a diastolic decrescendo murmur. One can hear it at the left lower sternal border. One may also hear it at the right lower sternal border (when associated with a dilated aorta). Other possible exam findings are bounding carotid and peripheral pulses. These are also known as Corrigan's pulse or [[Watson's water hammer pulse]]. Another possible finding is a widened [[pulse pressure]].
*[[Mitral stenosis]] presents as a diastolic low-pitched decrescendo murmur. It is best heard at the cardiac apex in the left lateral decubitus position. Mitral stenosis may have an opening snap. Increasing severity will shorten the time between S2 (A2) and the opening snap. For example, in severe MS the opening snap will occur earlier after A2.
*[[Tricuspid valve stenosis]] presents as a diastolic decrescendo murmur. One can hear it at the left lower sternal border. One may see signs of [[right heart failure]] on exam.
*[[Pulmonary valve insufficiency|Pulmonary valve regurgitation]] presents as a diastolic decrescendo murmur. One may hear it at the left lower sternal border. A palpable S2 in the second left intercostal space correlates with pulmonary hypertension due to mitral stenosis.
*The cooing dove murmur is a cardiac murmur with a musical quality (high pitched). Associated with aortic valve regurgitation (or mitral regurgitation before rupture of chordae). It is a diastolic murmur heard over the mid-precordium.<ref>{{cite journal |last1=Kohno |first1=Kenji |last2=Hiroki |first2=Tadayuki |last3=Arakawa |first3=Kikuo |title=Aortic regurgitation with dove-coo murmur with special references to the mechanism of its generation using dual echocardiography. |journal=Japanese Heart Journal |date=1981 |volume=22 |issue=5 |pages=861–869 |doi=10.1536/ihj.22.861 |pmid=7321208 |url=https://www.jstage.jst.go.jp/article/ihj1960/22/5/22_5_861/_pdf |access-date=17 November 2022 |language=en|doi-access=free }}</ref>

====Continuous and combined systolic-diastolic====

*[[Patent ductus arteriosus]] may present as a continuous murmur radiating to the back.
*[[Coarctation of the aorta|Severe coarctation of the aorta]] can present with a continuous murmur. One may hear the systolic component at the left infraclavicular region and the back. This is due to the stenosis. One may hear the diastolic component over the chest wall. This is due to blood flow through collateral vessels.
*[[Aortic valve regurgitation|Acute severe aortic regurgitation]] may present with a three phase murmur. First, a midsystolic murmur followed by S2. Following this is a parasternal early diastolic and mid-diastolic murmur ([[Austin Flint murmur]]). The exact cause of an Austin Flint murmur is unknown. Hypothesis is that the mechanism of murmur is from the severe aortic regurgitation. In severe aortic regurgitation the jet vibrates the anterior mitral valve leaflet. This causes collision with the mitral inflow during diastole. As such, the mitral valve orifice narrows. This results in increased mitral inflow velocity. This leads to the jet impinging on the myocardial wall.<ref>{{cite journal |title=Images in Cardiovascular Medicine Austin Flint Murmur |author1=John Oshinski |author2=Robert Franch, MD |author3=Murray Baron, MD |author4=Roderic Pettigrew, MD |journal=Circulation |year=1998 |volume=98 |pages=2782–2783 |pmid= 9851968 |doi=10.1161/01.cir.98.24.2782 |issue=24|doi-access=free }}</ref><ref>{{cite web|title=Blaufuss Multimedia - Heart Sounds and Cardiac Arrhythmias|url=http://www.blaufuss.org/|publisher=Medical Multimedia Laboratories|access-date=2 August 2013|url-status=live|archive-url=https://web.archive.org/web/20070829110332/http://www.blaufuss.org/|archive-date=29 August 2007}}</ref>
*Ruptured [[aortic sinus]] (sinus of Valsalva) may present as a continuous murmur. This is an uncommon cause of continuous murmur.<ref>{{cite journal|last=Topi|first=Bernard|author2=John|title=An uncommon cause of a continuous murmur.|journal=Experimental and Clinical Cardiology|date=September 2012|volume=17|pages=148–149|pmid=23620707|pmc=3628432|issue=3}}</ref> One may hear it at the aortic area and along the left sternal border.