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When the mitral valve fails to close fully in systole, blood regurgitates from left ventricle to left atrium, causing a murmur. This leakage creates a volume overload on the left ventricle, with subsequent dilatation and hypertrophy. Several structural abnormalities cause this condition, and findings may vary accordingly.

Tricuspid Regurgitation When the tricuspid valve fails to close fully in systole, blood regurgitates from right ventricle to right atrium, producing a murmur. The most common cause is right ventricular failure and dilatation, with resulting enlargement of the tricuspid orifice. Either pulmonary hypertension or left ventricular failure is the usual initiating cause.

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Ventricular Septal Defect lilllilllll

A ventricular septal defect is a congenital abnormality in which blood flows from the relatively high-pressure left ventricle into the low-pressure right ventricle through a hole. The defect may be accompanied by other abnormalities, but an uncomplicated lesion is described here.

other structure that should be closed. The murmur begins immediately with Si and continues up to S2.

Murmur

Associated Findings

Location. Apex

Radiation. To the left axilla, less often to the left sternal border

Intensity. Soft to loud; if loud, associated with an apical thrill

Pitch. Medium to high

Qiiality. Blowing

Aids. Unlike tricuspid regurgitation, it does not become louder in inspiration.

Location. Lower left sternal border

Radiation. To the right of the sternum, to the xiphoid area, and perhaps to the left midclavicular line, but not into the axilla

Intensity. Variable

Pitch. Medium

Qiiality. Blowing

Aids. Unlike mitral regurgitation, the intensity may increase slightly with inspiration.

Location. 3rd, 4th, and 5th left interspaces

Radiation. Often wide Intensity. Often very loud, with a thrill Pitch. High Qiiality. Often harsh

Si is often decreased.

An apical S3 reflects volume overload on the left ventricle.

The apical impulse is increased in amplitude and may be prolonged.

The right ventricular impulse is increased in amplitude and may be prolonged.

An S3 may be audible along the lower left sternal border. The jugular venous pressure is often elevated, and large v waves may be seen in the jugular veins.

A2 may be obscured by the loud murmur.

Findings vary with the severity of the defect and with associated lesions.

TABLE 7-8 ■ Diastolic Murmurs

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