Murmur: Difference between revisions

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==Grading==
== Description ==

{|
=== Location ===
| Grade | Description

* Aortic valve/right upper sternal border: second intercostal space at the right sternal border
* Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border
* Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border
* Mitral valve/point of maximal impulse/apex: approximately the fifth intercostal space at the left midclavicular line
* Radiation

===Intensity===
{| class="wikitable"
!Grade
!Description
|-
|-
|Grade 1
| Grade 1 | Faintest sound that can be detected
|Faintest sound that can be detected
|-
|-
|Grade 2
| Grade 2 | Soft murmur that is readily detectable
|Soft murmur that is readily detectable
|-
|-
|Grade 3
| Grade 3 | Louder than grade 2 but not associated with a palpable thrill
|Louder than grade 2 but not associated with a palpable thrill
|-
|-
|Grade 4
| Grade 4 | Associated with a palpable thrill
|Associated with a palpable thrill
|-
|-
|Grade 5
| Grade 5 | Audible with stethoscope placed lightly on the chest
|Audible with stethoscope placed lightly on the chest
|-
|-
|Grade 6
| Grade 6 | Audible with stethoscope off the chest
|Audible with stethoscope off the chest
|}
|}


=== Quality ===

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

=== Profile ===

* Crescendo, decrescendo, crescendo-decrescendo, or plateau

=== Timing ===

* Systolic, diastolic
* Early, mid, or late
* Holosystolic

== Interpretation ==
{| class="wikitable sortable mw-collapsible"
! rowspan="2" |Valvulopathy
! colspan="5" |Description
! colspan="5" |Maneuvers
! colspan="3" |Position
|-
!Location
!Radiation
!Timing
!Quality
!Profile
!Inspiration
!Isometric Handgrip (↑ Afterload)
!Squatting (↑ Preload)
!Valsalva (↓ Preload)
!Release Valsalva
!Left Lateral Decubitus
!Learning Forward
!Supine
|-
|Innocent
|LSB
|±apex
|mid-systolic
|musical, vibratory
|
|
|
|
|↓
|
|
|
|↑
|-
|[[Aortic regurgitation]]
|LLSB or PMI
|±LUSB
|diastolic
|blowing
|D
|↓
|↑
|↑
|
|↑
|
|↑
|
|-
|↳[[Austin Flint murmur|Austin Flint]]
|PMI
|
|mid-diastolic
|rumble
|
|
|
|
|
|
|
|
|
|-
|[[Aortic stenosis]]
|RUSB
|±carotids
|mid-systolic
|
|C-D
|↓
|
|↑
|↓
|↑
|
|↑
|
|-
|[[Mitral regurgitation]]
|PMI
|±left axilla
|holosystolic
|
|
|↓
|↑
|↑
|↓
|
|↑
|
|
|-
|[[Mitral valve prolapse]]
|PMI
|
|early systolic
|click
|
|↓
|↓
|↓
|↑
|
|
|
|
|-
|[[Mitral stenosis]]
|PMI
|
|mid-diastolic
|±OS, loud S1, rumble
|D
|↓
|
|↑
|↓
|
|↑
|
|
|-
|[[Pulmonic regurgitation]]
|
|
|
|
|
|↑
|
|
|
|↑
|
|
|
|-
|[[Pulmonic stenosis]]
|LUSB
|
|systolic
|
|C-D
|↑
|
|
|
|↑
|
|
|
|-
|[[Tricuspid regurgitation]]
|LLSB
|
|systolic
|
|
|↑
|
|
|
|
|
|
|
|-
|[[Tricuspid stenosis]]
|LLSB
|
|diastolic
|
|
|↑
|
|
|↓
|↓
|
|
|
|-
|[[Atrial septal defect]]
|LUSB
|
|
|may be harsh; fixed split S2
|
|
|
|
|
|
|
|
|
|-
|[[Ventricular septal defect]]
|PMI
|
|holosystolic
|loud, high-pitched, harsh
|
|
|↑
|
|↓
|
|
|
|
|-
|[[Hypertrophic obstructive cardiomyopathy]]
|PMI to LLSB
|
|mid-systolic
|harsh
|C-D
|
|↓
|↓
|↑
|
|
|
|
|-
|[[Patent ductus arteriosus]]
|LUSB
|
|continuous
|machine-like
|
|
|
|
|
|
|
|
|
|}
[[Category:Clinical exam]]
[[Category:Clinical exam]]
[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 17:33, 15 March 2022

Description

Location

  • Aortic valve/right upper sternal border: second intercostal space at the right sternal border
  • Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border
  • Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border
  • Mitral valve/point of maximal impulse/apex: approximately the fifth intercostal space at the left midclavicular line
  • Radiation

Intensity

Grade Description
Grade 1 Faintest sound that can be detected
Grade 2 Soft murmur that is readily detectable
Grade 3 Louder than grade 2 but not associated with a palpable thrill
Grade 4 Associated with a palpable thrill
Grade 5 Audible with stethoscope placed lightly on the chest
Grade 6 Audible with stethoscope off the chest

Quality

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

Profile

  • Crescendo, decrescendo, crescendo-decrescendo, or plateau

Timing

  • Systolic, diastolic
  • Early, mid, or late
  • Holosystolic

Interpretation

Valvulopathy Description Maneuvers Position
Location Radiation Timing Quality Profile Inspiration Isometric Handgrip (↑ Afterload) Squatting (↑ Preload) Valsalva (↓ Preload) Release Valsalva Left Lateral Decubitus Learning Forward Supine
Innocent LSB ±apex mid-systolic musical, vibratory ↓ ↑
Aortic regurgitation LLSB or PMI ±LUSB diastolic blowing D ↓ ↑ ↑ ↑ ↑
↳Austin Flint PMI mid-diastolic rumble
Aortic stenosis RUSB ±carotids mid-systolic C-D ↓ ↑ ↓ ↑ ↑
Mitral regurgitation PMI ±left axilla holosystolic ↓ ↑ ↑ ↓ ↑
Mitral valve prolapse PMI early systolic click ↓ ↓ ↓ ↑
Mitral stenosis PMI mid-diastolic ±OS, loud S1, rumble D ↓ ↑ ↓ ↑
Pulmonic regurgitation ↑ ↑
Pulmonic stenosis LUSB systolic C-D ↑ ↑
Tricuspid regurgitation LLSB systolic ↑
Tricuspid stenosis LLSB diastolic ↑ ↓ ↓
Atrial septal defect LUSB may be harsh; fixed split S2
Ventricular septal defect PMI holosystolic loud, high-pitched, harsh ↑ ↓
Hypertrophic obstructive cardiomyopathy PMI to LLSB mid-systolic harsh C-D ↓ ↓ ↑
Patent ductus arteriosus LUSB continuous machine-like
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