Murmurs DDx


  • Heart murmurs are abnormal heart sounds believed to be caused by turbulent flow across heart valves or vascular abnormalities.
  • When assessing a murmur, determine 6 characteristics: position at which it is loudest, grade, timing, duration, presence of a thrill, radiation and changes during respiration or with dynamic manoeuvers.


Continuous murmur

  • Patent ductus arteriosus
  • Arteriovenous fistula (coronary artery, pulmonary, systemic)
  • Aortopulmonary connection (e.g. congenital, Blalock shunt)
  • Venous hum (usually best heard over right supraclavicular fossa and abolished by ipsilateral internal jugular vein compression)
  • Rupture of sinus of Valsalva into right ventricle or atrium
  • ‘Mammary souffle’ (in late pregnancy or early postpartum period)

Mid-systolic murmur

  • Aortic stenosis
  • Pulmonary stenosis
  • Hypertrophic cardiomyopathy
  • Pulmonary flow murmur of an atrial septal defect

Pansystolic murmur

  • Mitral regurgitation
  • Tricuspid regurgitation
  • Ventricular septal defect
  • Aortopulmonary shunts

Early diastolic murmur

  • Aortic regurgitation
  • Pulmonary regurgitation

Mid-diastolic murmur

  • Mitral stenosis
  • Tricuspid stenosis
  • Atrial myxoma
  • Austin Flint murmur of aortic regurgitation
  • Carey Coombs murmur of acute rheumatic fever

Presystolic murmur

  • Mitral stenosis
  • Tricuspid stenosis
  • Atrial myxoma

References and Links


Journal Articles and Textbooks

  • Talley NJ, O’Connor S. Clinical Examination: A Systematic Guide to Physical Diagnosis. MacLennan and Petty. 3rd edition, 1998.

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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