In VSD, a diastolic rumble can be heard in addition to the holosystolic murmur due to movement across which phase?

• A. Movement across the valve during diastole
• B. Movement across the valve during systole
• C. Movement across the valve during expiration
• D. Movement across the valve during a systolic and diastolic interval

Answer: (A)

In a large VSD with a significant left-to-right shunt, there is increased return of blood to the left atrium and greater flow across the mitral valve during diastole. This diastolic flow across the mitral valve becomes turbulent, producing a low-pitched diastolic rumble heard at the apex. The holosystolic murmur is from the shunt across the septum during systole, not diastole. The diastolic rumble is specifically due to movement of blood across the mitral valve during diastole, not during expiration or across both systole and diastole.