Which murmur is described as harsh and radiates to the carotids?

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Harsh, carotid-radiating murmurs point to aortic stenosis. This is a systolic ejection murmur with a crescendo–decrescendo shape and a rough, harsh quality caused by turbulent flow across a narrowed aortic valve. It typically peaks in midsystole and is best heard at the right upper sternal border, with sound transmitted up into the carotid arteries, hence the radiation. Other murmurs have different timing and radiation patterns: mitral regurgitation is a holosystolic murmur at the apex that often radiates to the axilla; aortic regurgitation is a diastolic decrescendo murmur best heard along the left sternal border; tricuspid regurgitation is a holosystolic murmur at the left lower sternal border, sometimes louder with inspiration. The combination of harsh quality and carotid radiation best identifies aortic stenosis.