Describe TR Murmur and VSD murmur in details?

TR Murmur :  Characteristic: Holosystolic murmur, loudest at left lower-sternal border and becomes louder with inspiration (Carvallo sign).

VSD Murmur : Characteristic: The murmur of a moderate or large VSD is holosystolic and loudest along the lower left sternal border and is usually accompanied by a thrill. With development of pulmonary NT, the pressure gradient between left and right ventricle diminishes; Hence, the systolic murmur and thrill soften and finally disappear.

Small, muscular VSD may produce prominent high-frequency ejection systolic murmur that end before the end of systole if the contracting septal nucleic loses the defect.

In the setting of acute MI, a pansystolic murmur due to VSD can be differentiated from that due to ruptured papillary muscle:
- More than 50 per cent of VSD murmurs are associated with thrill and are loudest medial to apex.
- MR murmur very rarely associated with thrill and is loudest lateral to apex.