Heart murmur: Difference between revisions

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(Created page with "== Grading == * Grade 1: faint murmur, barely audible after waiting and focusing * Grade 2: quiet murmur but readily heard * Grade 3: easily audible but without a palpable thrill * Grade 4: easily audible and with a palpable thrill * Grade 5: loud murmur, audible with stethoscope lightly touching the chest * Grade 6: loudest murmur, audible with stethoscope not touching the chest Category:Cardiology Category:Clinical exam")
 
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== Grading ==
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== Clinical Examination ==
   
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=== Location ===
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* Grade 1: faint murmur, barely audible after waiting and focusing
  
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* Grade 2: quiet murmur but readily heard
  
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* Grade 3: easily audible but without a palpable thrill
  
−
* Grade 4: easily audible and with a palpable thrill
  
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* Grade 5: loud murmur, audible with stethoscope lightly touching the chest
  
−
* Grade 6: loudest murmur, audible with stethoscope not touching the chest
  
   
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* Valves have characteristic locations at which their murmurs are usually heard best
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* Murmurs may radiate
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  +
{| class="wikitable"
  +
!Location
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!Valve
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|-
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|Right upper sternal border at second intercostal space
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|aortic valve
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|-
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|Left upper sternal border at second intercostal space
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|pulmonary valve
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|-
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|Left lower sternal border at fourth intercostal space
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|tricuspid valve
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|-
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|point of maximal impulse of apex, left midclavicular line at the fifth intercostal space
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|mitral valve
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|}
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  +
=== Intensity ===
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{| class="wikitable"
  +
!Grade
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!Description
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|-
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|Grade 1
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|faint murmur, barely audible after waiting and focusing
  +
|-
  +
|Grade 2
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|quiet murmur but readily heard
  +
|-
  +
|Grade 3
  +
|easily audible but without a palpable thrill
  +
|-
  +
|Grade 4
  +
|easily audible and with a palpable thrill
  +
|-
  +
|Grade 5
  +
|loud murmur, audible with stethoscope lightly touching the chest
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|-
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|Grade 6
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|loudest murmur, audible with stethoscope not touching the chest
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|}
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  +
=== Pitch ===
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* High or low frequency
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* Blowing, harsh, musical, rumbling, squeaky
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  +
=== Profile ===
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* Crescendo, decrescendo, crescendo-decrescendo, plateau
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  +
=== Timing ===
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* Systolic or diastolic
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* Early, mid, late, holosystolic, or continuous
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  +
== Characteristic Murmurs ==
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{| class="wikitable sortable"
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!Murmur
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!Location
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!Profile
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!Timing
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!Pitch
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!Notes
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|-
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|[[Aortic stenosis]]
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|RUSB, may radiate to carotid arteries
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|crescendo-decrescendo
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|systolic
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|
  +
|
  +
|-
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|[[Aortic regurgitation]]
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|LLSB
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|descrescendo
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|diastolic
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|blowing
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|
  +
|-
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|[[Aortic regurgitation]], Austin-Flint murmur
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|PMI
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|
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|mid-diastolic
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|rumbling
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|may be mistaken for mitral stenosis
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|-
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|Flow murmur
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|
  +
|
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|mid-systolic
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|
  +
|
  +
|-
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|[[Pulmonary stenosis]]
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|LUSB
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|
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|systolic
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|
  +
|
  +
|-
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|[[Tricuspid stenosis]]
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|LLSB
  +
|
  +
|diastolic
  +
|
  +
|
  +
|-
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|[[Tricuspid regurgitation]]
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|LLSB
  +
|
  +
|systolic
  +
|
  +
|
  +
|-
  +
|[[Mitral stenosis]]
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|PMI
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|
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|diastolic
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|
  +
|
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|-
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|[[Mitral regurgitation]]
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|PMI, may radiate to left axilla
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|
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|systolic
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|
  +
|
  +
|-
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|[[Pulmonic stenosis]]
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|LUSB
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|crescendo-decrescendo
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|systolic ejection
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|
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|
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|-
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|[[Atrial septal defect]]
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|
  +
|
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|
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|
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|wide fixed split S2 at LUSB
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|-
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|[[Ventricular septal defect]]
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|PMI
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|
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|holosystolic
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|
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|
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|-
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|[[HOCM]]
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|between PMI and LLSB
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|
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|systolic
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|
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|
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|-
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|[[PDA]]
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|LUSB
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|
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|continuous
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|
  +
|
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|}
 
[[Category:Cardiology]]
  
[[Category:Cardiology]]
 
[[Category:Clinical exam]]
  
[[Category:Clinical exam]]

Latest revision as of 09:46, 1 August 2024

Clinical Examination

Location

  • Valves have characteristic locations at which their murmurs are usually heard best
  • Murmurs may radiate
Location Valve
Right upper sternal border at second intercostal space aortic valve
Left upper sternal border at second intercostal space pulmonary valve
Left lower sternal border at fourth intercostal space tricuspid valve
point of maximal impulse of apex, left midclavicular line at the fifth intercostal space mitral valve

Intensity

Grade Description
Grade 1 faint murmur, barely audible after waiting and focusing
Grade 2 quiet murmur but readily heard
Grade 3 easily audible but without a palpable thrill
Grade 4 easily audible and with a palpable thrill
Grade 5 loud murmur, audible with stethoscope lightly touching the chest
Grade 6 loudest murmur, audible with stethoscope not touching the chest

Pitch

  • High or low frequency
  • Blowing, harsh, musical, rumbling, squeaky

Profile

  • Crescendo, decrescendo, crescendo-decrescendo, plateau

Timing

  • Systolic or diastolic
  • Early, mid, late, holosystolic, or continuous

Characteristic Murmurs

Murmur Location Profile Timing Pitch Notes
Aortic stenosis RUSB, may radiate to carotid arteries crescendo-decrescendo systolic
Aortic regurgitation LLSB descrescendo diastolic blowing
Aortic regurgitation, Austin-Flint murmur PMI mid-diastolic rumbling may be mistaken for mitral stenosis
Flow murmur mid-systolic
Pulmonary stenosis LUSB systolic
Tricuspid stenosis LLSB diastolic
Tricuspid regurgitation LLSB systolic
Mitral stenosis PMI diastolic
Mitral regurgitation PMI, may radiate to left axilla systolic
Pulmonic stenosis LUSB crescendo-decrescendo systolic ejection
Atrial septal defect wide fixed split S2 at LUSB
Ventricular septal defect PMI holosystolic
HOCM between PMI and LLSB systolic
PDA LUSB continuous
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