Timing | Quality and pitch | Location | Possible causes |
---|
Midsystolic (systolic ejection) | Harsh, rough with medium to high pitch | Pulmonic | Pulmonic stenosis |
Harsh, rough with medium to high pitch | Aortic and suprasternal notch | Aortic stenosis |
Holosystolic (pansystolic) | Harsh with high pitch | Tricuspid | Ventricular septal defect |
Blowing with high pitch | Mitral, lower left sternal border | Mitral insufficiency |
Blowing with high pitch | Tricuspid | Tricuspid insufficiency |
Early diastolic | Blowing with high pitch | Midleft sternal edge (not aortic area) | Aortic insufficiency |
Blowing with high pitch | Pulmonic | Pulmonic insufficiency |
Mid-diastolic to late diastolic | Rumbling with low pitch | Apex | Mitral stenosis |
Rumbling with low pitch | Tricuspid, lower right sternal border | Tricuspid stenosis |