Pansystolic murmurs are
heard from beginning of S1 and up to S2, where as ejection systolic murmurs are
heard from midsystole and end well before S2.
Duration (intensity not
always) of ejection murmurs can increase with increasing severity of
stenosis. Ejection systolic murmurs have
crescendo and decrescendo character, peaking occurs more later with increasing
severity of murmurs. Usually ESM tend
decrease in intensity at the end of systole because ejection tend reduce.
classically have same intensity throughout systole, they tend not decrease towards
later part of systole sometimes they may increase in intensity towards end of
murmurs began with S1 due to dampening effect of S1, initial part of murmurs
may not be heard, although is recorded phonocardiographically. So clinical differentiation
of Pansystolic from ejection systolic murmur, is by concentrating on end of
systole; is murmur well heard before S2, or there is definite gap between
murmur and S2, if gap is present than it is sign of ejection systolic murmur
Late systolic murmurs
like pansystolic murmurs are also heard well up to S2.
Early systolic murmurs occur
early in systole and end well before S2