• holosystolic
• high-pitched
• blowing
• loudest at apex
• radiates toward axilla
• enhanced by ↑ TPR

• holosystolic
• high-pitched
• blowing
• loudest at tricuspid area
• radiates to right sternal border
• enhanced by maneuvers that ↑ RA return (inspiration)

• Systolic
• crescendo-decrescendo
• follows ejection click
• radiates to carotids/apex

• holosystolic
• harsh-sounding
• loudest at tricuspid area

• late systolic crescendo
• following midsystolic click
• Loudest at S2
• most frequent valvular lesion
• enhanced by ↓ venous return (standing, valsalva)

• diastolic
• high-pitched blowing
• see a wide pulse pressure when chronic

• late diastolic murmur
• delayed rumbling
• follows opening snap
• enhanced by ↑ LA return (ex: expiration)

****99% are secondary to Rheumatic Fever (fibrosed and fused commissures on gross image)

• continuous machine-like murmur
• loudest at S2