Is the murmur "innocent" or is it indicative of valvular involvement? But a short while ago this question would arise only when the murmur was systolic, never diastolic. A systolic murmur left the door open to benign interpretation, particularly if it was heard late in systole. Its "innocence" then would be taken for granted. In contrast, a diastolic murmur was always taken seriously. Its "organic" origin was not in question, and if the murmur occurred early in diastole and was soft, blowing, decrescendo in character, the diagnosis of aortic or pulmonary valve incompetence was almost certain.
A reappraisal—if not a turnabout—in interpreting late systolic and early diastolic murmurs has taken place in recent years. In 1963, Barlow1 established the association of the late systolic murmur with mitral valve prolapse. The systolic click-murmur syndrome has since become a subject of investigation and controversy.
No such drastic change has occurred in
Vaisrub S. Diastolic Murmur of Renal Failure. JAMA. 1977;237(5):476–477. doi:10.1001/jama.1977.03270320054027
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