Clinical exam · Cardiovascular system
Valve murmurs: the table to know !
- Topic
The seven most-tested murmurs side by side in one table: when they sound, where, where they travel and what changes them.
Updated 2026-11-01
See it in 3D: Aortic right coronary cusp · Aortic left coronary cusp · Aortic non-coronary cusp · Mitral anterior leaflet · Mitral posterior leaflet · Tricuspid anterior leaflet · Interventricular septum
What it is
Almost every murmur question is solved with four facts: timing in the cycle, location, radiation and response to maneuvers. This table puts the classic adult valve lesions and the ventricular septal defect together. Echocardiography confirms; the table guides at the bedside.
Key facts
- Systolic: aortic and pulmonic stenosis, mitral and tricuspid regurgitation, ventricular septal defect, mitral valve prolapse.
- Diastolic: aortic and pulmonic regurgitation, mitral and tricuspid stenosis; always pathologic.
- Right-sided murmurs get louder on inspiration; left-sided ones on expiration.
- Only two systolic murmurs grow with Valsalva and standing: hypertrophic obstructive cardiomyopathy and mitral valve prolapse (which lengthens).
- Companion signs: pulsus parvus et tardus in aortic stenosis; bounding pulse and wide pulse pressure in aortic regurgitation; loud S1 in mitral stenosis.
Classic valve murmurs. ↑ louder, ↓ softer. Handgrip = sustained squeeze (raises afterload).
| Lesion | Timing | Best heard | Radiation | What changes it |
|---|---|---|---|---|
| Aortic stenosis | Midsystolic, diamond-shaped, harsh | Aortic area (right 2nd space) | Carotids | ↑ squatting; ↓ Valsalva, standing, handgrip |
| Aortic regurgitation | Early diastolic, decrescendo, blowing | Left sternal border (3rd–4th space) | Toward the apex | ↑ handgrip and sitting forward in expiration |
| Mitral stenosis | Mid-diastolic rumble after an opening snap | Apex, with the bell | Little or none | ↑ left lateral decubitus and exercise; ↓ Valsalva |
| Mitral regurgitation | Holosystolic, blowing | Apex | Left axilla | ↑ handgrip and squatting; ↓ Valsalva and standing |
| Mitral valve prolapse | Midsystolic click and late systolic murmur | Apex | Left axilla | Valsalva or standing: earlier click, longer murmur; squatting: later |
| Tricuspid regurgitation | Holosystolic, blowing | Lower left sternal border | Right sternal border and xiphoid | ↑ inspiration (Carvallo sign) |
| Ventricular septal defect | Holosystolic, harsh | Left sternal border (3rd–4th space) | Across the precordium | ↑ handgrip; ↓ Valsalva |
Test yourself
Think of the answer, then tap the question to see it.
Where does the murmur of aortic stenosis radiate?
To the carotids, following the jet out of the aortic valve.
Which murmur is holosystolic at the apex and radiates to the left axilla?
Mitral regurgitation.
What happens to the click of mitral valve prolapse with the Valsalva maneuver?
It moves earlier in systole and the murmur lengthens, because the smaller left ventricle lets the leaflet prolapse sooner.
How is tricuspid regurgitation told from mitral regurgitation at the bedside?
Tricuspid is heard at the lower left sternal border and gets louder on inspiration (Carvallo sign); mitral is at the apex, radiates to the axilla and does not.
What does handgrip do to aortic stenosis and to mitral regurgitation?
It softens the aortic stenosis murmur and makes the mitral regurgitation murmur louder, because afterload rises.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
- Aortic right coronary cusp
- Aortic left coronary cusp
- Aortic non-coronary cusp
- Mitral anterior leaflet
- Mitral posterior leaflet
- Tricuspid anterior leaflet
- Interventricular septum
Related
- Murmurs: timing, grade, location and radiation
- Dynamic auscultation: Valsalva, squatting, standing and handgrip
- Cardiac auscultation: the areas and the order
- Heart sounds: S1, S2 and its splitting, S3 and S4
- Abnormal pulses: paradoxus, alternans, parvus et tardus, bounding
Related conditions
- Aortic Valve Stenosis
- Aortic regurgitation
- Mitral stenosis
- Mitral regurgitation
- Mitral valve prolapse
- Ventricular septal defect
- Hypertrophic cardiomyopathy
- Rheumatic heart disease
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Aortic stenosis: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Aortic regurgitation: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Mitral stenosis: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Mitral valve regurgitation: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Mitral valve prolapse: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); 24.3 Nursing Assessment - Clinical Nursing Skills | OpenStax (OpenStax (Rice University), 2024).
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Representative model, for educational purposes only.