approaching patient with murmurs and its differential diagnosis

1. D R . N I S H E E T H M P A T E L
3 R D Y E A R R E S I D E N T
M . D M E D I C I N E
Differential Diagnosis of
cardiac murmurs

2. D/D of systolic murmurs
At apex
Early systolic
murmrur
MR:
PMD/PMR
ruptured chorda
tendinae
TR
VSD
Rheumatic
Carditis
 Acute MR
VSD small muscular
part
 Ventricular
aneurysm
Pansystolic murmur
MVP
Late systolic
murmur

3. Approach to Pansystolic murmur

4. D/D of systolic murmurs
Left parasternal (3rd and 4th IC
space)
Mid systolic murmur
MR with post cusp
involvement
ASD septum
primum
VSD
 PS infundibular
 HOCM
 Innocent murmurs
 Transmittd
murmurs
Hyperdynamic
circulation
ASD
Valvular PS
TOF
Pansystolic murmur

5. D/D of systolic murmurs
Pulmonary area
Continuous
murmur
 AS
HOCM
Severe AR with AS
Sclerosed AoV
Ao root dilatation
Coarctation of Ao
Aorititis
PDA with
pulmonary HTN
Midsystolic murmur
Hyperdynamic
circulaiton
PS valvualr
ASD secundum
TOF
Pulm HTN d/t
MS ,COPD or
primary
Mid systolic
murmur
Aortic Area

6. D/D of Diastolic murmurs
At Apical area
AR
Aneurysm of
ascending Aorta
Early diastolic
murmur
MS
Severe MR
Austin flint murmur
of AR
Carey Coombs
murmur
LA myxoma
Mid diastolic
murmur
Pulmonary area Aortic Area
early diastolic
murmur
 PR

7. THANK
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