Heart murmur (pansystolic)

Pansystolic murmurs occur throughout systole, and may be caused by:

• mitral regurgitation:
  • the murmur is maximal at the apex and often in late systole
  • it is transmitted to the axilla
    
    
• ventricular septal defect with a left to right shunt:
  • the murmur is maximal at the left lower sternal edge, and may be loudest when the defect is small
    
    
• tricuspid regurgitation:
  • the murmur is maximal at the fourth left interspace with inspiratory augmentation and a systolic wave in the jugular venous pulse