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Diastolic flow rumbles are caused by high flow across the atrioventricular valves in patients having atrial septal defect (ASD), ventricular septal defect
(VSD), and patent ductus arteriosus (PDA). Shunting through the ASD results in high flow across the tricuspid valve, producing the tricuspid flow rumble
(TFR). In both VSD and PDA, left-to-right shunting through the VSD or PDA causes high flow across the mitral valve, resulting in a mitral flow rumble
(MFR). With both mitral regurgitation (MR) and tricuspid regurgitation (TR), the large regurgitation volume causes increased flow during early diastole
across the atrioventricular valve, resulting in MFR and TFR, respectively, both being introduced by a prominent third heart sound (S3). With inspiration,
there is a significant increase in the intensity of the pansystolic regurgitant tricuspid murmur (PRM), the S3, and the TFR. No significant changes in the
Source: Chapter 14. The History, Physical Examination, and Cardiac Auscultation, Hurst's The Heart, 13e
intensity of the diastolic flow rumbles occur with inspiration in patients have ASD, VSD, PDA, or MR. A2, aortic valve closure sound; M1, mitral valve
Citation:
Fuster V,valve
Walsh
RA, Harrington
RA. systolic
Hurst's The
Heart,
13e; 2011
Availablevalve
at: http://mhmedical.com/
Accessed:
Maymurmurs.
05, 2017 Heart
closure sound;
P2, pulmonary
closure
sound; SEM,
ejection
murmur,
T1, tricuspid
closure sound. Shaver
JA. Diastolic
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Dis Stroke. 1993;1:98-103. Reproduced with permission from the American Heart Association.