Abstract
The shape of the diastolic murmur of aortic regurgitation was studied in 5 patients with musical murmurs. Instead of the traditionally postulated, simple decrescendo type, which may be preceded by a short crescendo phase, the diastolic murmur often presents a characteristically complex form. The early diastolic peak may be followed by several elements of waxing and waning intensity. Various hemodynamic factors are suggested as possible causes of these features: (1) compression chamber action; (2) effect of tidal waves; and (3) impact of contraction of the atria upon the root of the aorta. Asynchronous contraction of the atria may bring about a sand-glass-shaped presystolic element of the diastolic murmur.
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