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

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