Apical diastolic and presystolic murmurs of proved functional nature

Sounds and pulses as aids to cardiac diagnosis

Areas of auscultation are reviewed. Heart sounds, clicks, snaps, and murmurs are discussed as they appear in various cardiac problems, particularly with respect to their usefulness in differential diagnosis.

Diastolic murmurs in apparently normal children

Diastolic murmurs have always been considered abnormal, but this report presents nine apparently normal children with high-frequency, early, diamond-shaped diastolic murmurs confirmed by intracavitary phonocardiography to arise within the left ventricle. Each child (aged 5 to 15 years) was referred for evaluation of a systolic murmur at the lower left sternal border, but an additional finding at the initial examination was a grade I to III/VI high-pitched diastolic murmur, thought to be decrescendo, at the third and fourth intercostal space at the left sternal edge. The murmurs were best heard when the patient was supine. Cardiac x-rays, including four views with barium, were all clearly normal, as were eight of the nine electrocardiograms and the Frank and McFee vectorcardiograms. Multiple parameters of right and left heart catheterizations were normal in all.