This document provides a differential diagnosis for various types of cardiac murmurs based on location and timing. It lists potential causes of early, mid, and late systolic murmurs at the apex, left parasternal area, pulmonary area, and aortic area. Causes include various valvular regurgitations and stenoses, septal defects, patent ductus arteriosus, coarctation of the aorta, and other structural issues. Diastolic murmurs are also differentiated based on timing and location, with listed potential causes like mitral stenosis, aortic regurgitation, and pulmonary regurgitation. The document serves as a guide for physicians to consider possible diagnoses when evaluating patients with cardiac murmurs.

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

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