Timing


Timing refers to the relationship of the murmur to the cardiac cycle.
Accordingly, murmurs are classified as:

Systolic - (Regurgitant and Ejection)
Diastolic - (Proto and Mid-diastolic)
Continuous

The table shows salient features and etiology of cardiac murmurs. More than one type of murmur may be present in the same child.

Type Features Diagnosis
 
Regurgitant S1 muffled

Murmur ends before A2

Mitral regurgitation

Ventricular septal defect

Ejection S1 normal, murmur may extend past A2

eg: severe pulmonic stenosis

Pulmonic or aortic valvar stenosis
Proto-diastolic Murmur begins with S2 Decrescendo Aortic/pulmonic valvar regurgitation
Mid-diastolic Low frequency Large ventricular and atrial septal defect. Mitral stenosis and Mitral regurgitation
Continuous Murmurs which begin with S1 and extend past A2 in diastole Patent ductus arteriosus

Back to Murmurs

Objectives | History | Physical Exam | Cardiac Cycle | Murmurs |
Criteria for Referral | Compare Sounds | Case Studies | Samples of Murmurs