Murmur: Difference between revisions

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=== Location ===
=== Location ===


* Aortic valve: second intercostal space at the right sternal border
* Aortic valve/right upper sternal border: second intercostal space at the right sternal border
* Pulmonary valve: second intercostal space at the left sternal border
* Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border
* Tricuspid valve: fourth intercostal space at the left sternal border
* Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border
* Mitral valve: fifth intercostal space at the left midclavicular line
* Mitral valve/point of maximal impulse/apex: approximately the fifth intercostal space at the left midclavicular line
* Radiation
* Radiation: Murmurs may radiate, allowing auscultation at remote locations


===Intensity===
===Intensity===
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== Interpretation ==
== Interpretation ==
{| class="wikitable"
{| class="wikitable sortable mw-collapsible"
! rowspan="2" |Valvulopathy
⚫
|+
! colspan="5" |Description
!
! colspan="5" |Maneuvers
! colspan="3" |Position
⚫
|-
!Location
!Location
!Radiation
!Radiation
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!Valsalva (↓ Preload)
!Valsalva (↓ Preload)
!Release Valsalva
!Release Valsalva
!Left Lateral Decubitus
!Learning Forward
!Supine
|-
|-
|Innocent
|Flow murmur
|
|LSB
|±apex
⚫
|
|mid-systolic
|mid-systolic
|musical, vibratory
|
|
|
|
|
|
|
|
|↓
|
|
|
|
|
|
|↑
|-
|-
|[[Aortic regurgitation]]
|[[Aortic regurgitation]]
|LLSB
|LLSB or PMI
|±LUSB
⚫
|
|diastolic
|diastolic
|blowing
|blowing
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|
|
|↑
|↑
⚫
|
|↑
⚫
|
|-
|-
|Aortic regurgitation, Austin Flint
|↳[[Austin Flint murmur|Austin Flint]]
|PMI
|PMI
|
|
|mid-diastolic
|mid-diastolic
|rumble
|rumble
⚫
|
⚫
|
⚫
|
|
|
|
|
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|RUSB
|RUSB
|±carotids
|±carotids
|systolic
|mid-systolic
|
|
|C-D
|C-D
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|↓
|↓
|↑
|↑
⚫
|
|↑
|
|-
|-
|[[Mitral regurgitation]]
|[[Mitral regurgitation]]
|PMI
|PMI
|±axillae
|±left axilla
|holosystolic
|systolic
|
|
|
|
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|↑
|↑
|↓
|↓
|
|↑
|
|
|
|-
|-
|[[Mitral valve prolapse]]
|[[Mitral valve prolapse]]
|
|PMI
|
|
|early systolic
|early systolic
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|↓
|↓
|↑
|↑
|
|
|
|
|
|-
|-
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|PMI
|PMI
|
|
|diastolic
|mid-diastolic
|±OS, loud S1, rumble
⚫
|
|
|D
|↓
|↓
|
|
|↑
|↑
|↓
|↓
|
|↑
|
|
|
|-
|-
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|
|
|↑
|↑
|
|
|
|-
|-
|[[Pulmonic stenosis]]
|[[Pulmonic stenosis]]
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|
|
|↑
|↑
|
|
|
|-
|-
|[[Tricuspid regurgitation]]
|[[Tricuspid regurgitation]]
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|
|
|↑
|↑
|
|
|
|
|
|
|
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|↓
|↓
|↓
|↓
|
|
|
|-
|-
|[[Atrial septal defect]]
|[[Atrial septal defect]]
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|
|
|may be harsh; fixed split S2
|may be harsh; fixed split S2
|
|
|
|
|
|
|
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|PMI
|PMI
|
|
|holosystolic
⚫
|
|loud, high-pitched, harsh
⚫
|
|
|
|
|
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|
|
|↓
|↓
|
|
|
|
|
|-
|-
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|PMI to LLSB
|PMI to LLSB
|
|
|systolic
|mid-systolic
|harsh
⚫
|
|
|C-D
|
|
|↓
|↓
|↓
|↓
|↑
|↑
|
|
|
|
|
|-
|-
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|continuous
|continuous
|machine-like
|machine-like
|
|
|
|
|
|
|

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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