Continuous murmur is seen in-

Continuous murmurs begin in systole, peak near the second hea sound, and continue into all or pa of diastole. Their presence throughout the cardiac cycle implies a pressure gradient between two chambers or vessels during both systole and diastole. The continuous murmur associated with a patent ductus aeriosus is best heard at the upper left sternal border. Large, uncorrected shunts may lead to pulmonary hypeension, attenuation or obliteration of the diastolic component of the murmur, reversal of shunt flow, and differential cyanosis of the lower extremities. A ruptured sinus of Valsalva aneurysm creates a continuous murmur of abrupt onset at the upper right sternal border. Rupture typically occurs into a right hea chamber, and the murmur is indicative of a continuous pressure difference between the aoa and either the right ventricle or the right atrium. A continuous murmur also may be audible along the left sternal border with a coronary aeriovenous fistula and at the site of an aeriovenous fistula used for hemodialysis access. Enhanced flow through enlarged intercostal collateral aeries in patients with aoic coarctation may produce a continuous murmur along the course of one or more ribs. A cervical bruit with both systolic and diastolic component usually indicates a high grade carotid aery stenosis. ref : Harrison&;s principles of internal medicine 20 th edition,pg no.13-7)