Table 1.

Cardiac murmurs.

Left/Right Side Thorax	Diagnosis	Typical Auscultatory Findings	Comments
Left side thorax
Systolic murmur	Physiologic (flow) murmur	PMI over aortic and pulmonic valve area Early‐to‐midsystolic Crescendo‐decrescendo or decrescendo Usually grade 1–3/6	Assumed to be caused by blood flow in aorta and pulmonary artery in early systole Generally localized and brief in duration Intensity might change with exercise
	Mitral regurgitation	PMI over mitral to aortic valve Holo‐ or pansystolic or mid‐to‐late systolic Plateau (band‐) shaped or mid‐to‐late crescendo Grade 1–6/6	Crescendo mid‐to‐late systolic murmur suggestive of mitral valve prolapse Musical holosystolic or mid‐to‐late systolic honking murmur suggestive of ruptured chordae tendineae
	Ventricular septal defect (subarterial)	PMI pulmonic valve area Plateau (band)‐shaped Grade 4–6/6	Often heard on right side but less loud Less common location Must distinguish from right ventricular outflow obstruction
Diastolic murmur	Physiologic (flow) murmur	PMI over mitral & tricuspid valve area Early‐diastolic (S2‐S3) or late‐diastolic (S4‐S1) Quality often musical/squeaking Grade 1–3/6	Assumed to be caused by ventricular filling
	Aortic regurgitation	PMI over aortic valve area Holo‐ or pandiastolic Decrescendo, musical, or both Grade 1–6/6	Usually radiates to the right as a slightly softer, but otherwise similar murmur
Systolic with diastolic component	Aorto‐pulmonary fistula (predominantly reported in Friesians)	PMI dorsal to aortic valve area Holosystolic and early‐to‐middiastolic	Can be fairly localized Bounding arterial pulses Usually tachycardic
Right side thorax
Systolic murmur	Tricuspid regurgitation	PMI over tricuspid valve Holo‐ or pansystolic Crescendo or band shaped Grade 1–6/6	Usually soft and blowing
	Ventricular septal defect(perimembranous)	PMI ventral to tricuspid valve Holo‐ or pansystolic Plateau (band‐) shaped Grade 4–6/6	Usually coarse Often a softer crescendo‐decrescendo murmur over pulmonic valve heard because of relative pulmonic stenosis
Continuous	Aorto‐cardiac fistula	PMI right side, also audible on left Harsh machinery Grade 3–6/6	Bounding arterial pulses Ventricular arrhythmias common initially