<prompt> Continuous murmur is present incardiomyopathyMSPDAcardiac tamponade  <response>: A continuous murmur is predicated on a pressure gradient that persists between two cardiac chambers or blood vessels across systole and diastole.The murmurstypically begin in systole, envelop the second heart sound S 2 , and continue through some portion of diastole.They can often be difficult to distinguish from individual systolic and diastolic murmurs in patients with mixed valvular heart disease. The classic example of a continuous murmur is that associated with a patent ductus arteriosus, which usually is heard in the second or third interspace at a slight distance from the sternal border. Other causes of a continuous murmur include a ruptured sinus of Valsalva aneurysm with creation of an aorticright atrial or right ventricular fistula, a coronary or great vessel arteriovenous fistula, and an arteriovenous fistula constructed to provide dialysis access. 