What characteristic is NOT associated with an ASD murmur?

An atrial septal defect (ASD) murmur is primarily characterized by certain distinctive features, and the presence of an intermittent silence is not one of them. An ASD typically presents with a fixed splitting of the second heart sound due to prolonged right ventricular systole as well as a wide split during inspiration because the volume overload to the right heart causes delays in the closure of the pulmonic valve.

The fixed split occurs consistently regardless of the patient's respiratory cycle, which is characteristic of ASDs. This is due to the continuous left-to-right shunting of blood, leading to increased blood flow into the right atrium and ventricle, which prolongs the duration of right ventricular ejection. Wide splitting is also evident, especially during inspiration, as the RV filling increases further and the delay in pulmonic valve closure becomes more pronounced.

The presence of systolic and diastolic components refers to the nature of the sounds generated during the heart's cycle, but the key takeaway is that intermittent silence does not occur with an ASD murmur. Intermittent silence is typically not a feature one would expect with the continuous nature of the flow issues from an ASD, where the murmurs are more consistently observed throughout the cardiac cycle. Thus, identifying intermittent