Carey coomb murmur is seen in -

A sho, mid-diastolic murmur is rarely heard during an episodeof acute rheumatic fever (Carey-Coombs murmur) and probably isdue to flow through an edematous mitral valve. An opening snapis not present in the acute phase, and the murmur dissipates withresolution of the acute attack. Complete hea block with dyssynchronousatrial and ventricular activation may be associated withintermittent mid- to late diastolic murmurs if atrial contractionoccurs when the mitral valve is paially closed. Mid-diastolic murmursindicative of increased tricuspid valve flow can occur withsevere, isolated TR and with large ASDs and significant left-to-rightshunting. Other signs of an ASD are present ( Chap. 236 ), includingfixed splitting of S 2 and a mid-systolic murmur at the mid- to upperleft sternal border. TTE is indicated for evaluation of a patient witha mid- to late diastolic murmur. Ref Harrison 20th edition pg 1545