Murmur: Difference between revisions
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== Description == |
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=== Location === |
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* Aortic valve: second intercostal space at the right sternal border |
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* Pulmonary valve: second intercostal space at the left sternal border |
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* Tricuspid valve: fourth intercostal space at the left sternal border |
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* Mitral valve: fifth intercostal space at the left midclavicular line |
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* Radiation: Murmurs may radiate, allowing auscultation at remote locations |
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===Intensity=== |
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{| class="wikitable" |
{| class="wikitable" |
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!Grade |
!Grade |
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=== Quality === |
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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, or plateau |
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=== Timing === |
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* Systolic, diastolic |
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* Early, mid, or late |
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* Holosystolic |
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== Interpretation == |
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{| class="wikitable" |
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|+ |
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!Location |
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!Radiation |
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!Timing |
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!Quality |
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!Profile |
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!Inspiration |
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!Isometric Handgrip (β Afterload) |
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!Squatting (β Preload) |
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!Valsalva (β Preload) |
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!Release Valsalva |
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|Flow murmur |
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|mid-systolic |
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|[[Aortic regurgitation]] |
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|LLSB |
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|diastolic |
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|blowing |
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|D |
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|β |
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|β |
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|β |
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|β |
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|Aortic regurgitation, Austin Flint |
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|PMI |
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|mid-diastolic |
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|rumble |
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|[[Aortic stenosis]] |
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|RUSB |
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|Β±carotids |
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|systolic |
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|C-D |
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|β |
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|β |
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|β |
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|β |
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|[[Mitral regurgitation]] |
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|PMI |
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|Β±axillae |
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|systolic |
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|β |
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|β |
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|β |
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|β |
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|[[Mitral valve prolapse]] |
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|early systolic |
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|click |
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|β |
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|β |
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|β |
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|β |
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|[[Mitral stenosis]] |
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|PMI |
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|diastolic |
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|β |
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|β |
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|β |
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|[[Pulmonic regurgitation]] |
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|β |
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|β |
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|[[Pulmonic stenosis]] |
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|LUSB |
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|systolic |
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|C-D |
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|β |
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|β |
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|[[Tricuspid regurgitation]] |
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|LLSB |
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|systolic |
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|β |
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|[[Tricuspid stenosis]] |
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|LLSB |
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|diastolic |
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|β |
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|β |
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|β |
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|[[Atrial septal defect]] |
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|LUSB |
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|may be harsh; fixed split S2 |
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|[[Ventricular septal defect]] |
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|PMI |
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|β |
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|β |
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|[[Hypertrophic obstructive cardiomyopathy]] |
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|PMI to LLSB |
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|systolic |
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|β |
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|β |
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|β |
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|[[Patent ductus arteriosus]] |
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|LUSB |
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|continuous |
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|machine-like |
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[[Category:Clinical exam]] |
[[Category:Clinical exam]] |
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[[Category:Cardiology]] |
[[Category:Cardiology]] |
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Revision as of 17:19, 15 March 2022
Description
Location
- Aortic valve: second intercostal space at the right sternal border
- Pulmonary valve: second intercostal space at the left sternal border
- Tricuspid valve: fourth intercostal space at the left sternal border
- Mitral valve: fifth intercostal space at the left midclavicular line
- Radiation: Murmurs may radiate, allowing auscultation at remote locations
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
| Location | Radiation | Timing | Quality | Profile | Inspiration | Isometric Handgrip (β Afterload) | Squatting (β Preload) | Valsalva (β Preload) | Release Valsalva | |
|---|---|---|---|---|---|---|---|---|---|---|
| Flow murmur | mid-systolic | |||||||||
| Aortic regurgitation | LLSB | diastolic | blowing | D | β | β | β | β | ||
| Aortic regurgitation, Austin Flint | PMI | mid-diastolic | rumble | |||||||
| Aortic stenosis | RUSB | Β±carotids | systolic | C-D | β | β | β | β | ||
| Mitral regurgitation | PMI | Β±axillae | systolic | β | β | β | β | |||
| Mitral valve prolapse | early systolic | click | β | β | β | β | ||||
| Mitral stenosis | PMI | diastolic | β | β | β | |||||
| Pulmonic regurgitation | β | β | ||||||||
| Pulmonic stenosis | LUSB | systolic | C-D | β | β | |||||
| Tricuspid regurgitation | LLSB | systolic | β | |||||||
| Tricuspid stenosis | LLSB | diastolic | β | β | β | |||||
| Atrial septal defect | LUSB | may be harsh; fixed split S2 | ||||||||
| Ventricular septal defect | PMI | β | β | |||||||
| Hypertrophic obstructive cardiomyopathy | PMI to LLSB | systolic | β | β | β | |||||
| Patent ductus arteriosus | LUSB | continuous | machine-like |
