How to differentiate ejection murmurs from systolic regurgitant murmurs.

Although it is not possible to distinguish the shape of a murmur as being crescendo-decrescendo as in ejection murmurs from a plateau-shaped regurgitant systolic murmur by hearing the murmur alone, it is possible to distinguish them by auscultation with the use of other characteristics that give clues to their shape or their origin. With the use of accompanying heart sounds, the peak of the crescendo-decrescendo effect of ejection murmurs makes a recognizable rhythm which is absent in the plateau-shaped regurgitant murmur. When no heart sounds are present, the increase in loudness after a sudden long diastole of only the ejection murmur can help to separate the two types of murmur. The term "midsystolic" as applied to the ejection murmur is misleading and should be avoided because it is based on controversial hemodynamics and it obstructs teaching the significance of early, mid, and late peaks to ejection murmurs.