Mitral vs. Aortic Murmurs

The systolic murmurs of mitral insufficiency and aortic stenosis can be confused on auscultation. Both murmurs can be present in the same patient.

Mitral insufficiency murmurs are:

• High pitched, blowing
• Do not radiate to the neck
• Increase with handgrip
• Do not increase after a premature ventricular beat
• An atrial (S4) gallop is absent, except in severe acute mitral insufficiency
• Decrease with amyl nitrite

Aortic stenosis murmurs are:

• Lower pitched, except when they are musical
• Radiate to the neck
• Do not increase with handgrip
• Increase after a premature ventricular beat
• An atrial (S4) gallop may be present
• Increase with amyl nitrite

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