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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− | == |
+ | == Clinical Examination == |
+ | === 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 |
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− | * Grade 4: easily audible and with a palpable thrill |
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− | * Grade 5: loud murmur, audible with stethoscope lightly touching the chest |
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− | * 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" |
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+ | !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" |
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+ | !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 |
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+ | |- |
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+ | |Grade 2 |
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+ | |quiet murmur but readily heard |
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+ | |- |
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+ | |Grade 3 |
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+ | |easily audible but without a palpable thrill |
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+ | |- |
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+ | |Grade 4 |
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+ | |easily audible and with a palpable thrill |
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+ | |- |
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+ | |Grade 5 |
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+ | |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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+ | | |
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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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+ | |- |
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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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+ | | |
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+ | |mid-systolic |
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+ | | |
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+ | | |
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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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+ | | |
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+ | |- |
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+ | |[[Tricuspid stenosis]] |
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+ | |LLSB |
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+ | | |
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+ | |diastolic |
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+ | | |
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+ | | |
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+ | |- |
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+ | |[[Tricuspid regurgitation]] |
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+ | |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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+ | |[[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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+ | |- |
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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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+ | | |
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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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+ | | |
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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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+ | | |
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+ | |} |
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[[Category:Cardiology]] |
[[Category:Cardiology]] |
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[[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 |