Murmur: Difference between revisions

Revision as of 17:31, 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

Valvulopathy	Description					Maneuvers					Position
Valvulopathy	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

@@ Line 49: / Line 49: @@
 == Interpretation ==
-{| class="wikitable"
+{| class="wikitable sortable mw-collapsible"
+! rowspan="2" |Valvulopathy
-|+
+! colspan="5" |Description
-!Valvulopathy
+! colspan="5" |Maneuvers
+! colspan="3" |Position
+|-
 !Location
 !Radiation
@@ Line 62: / Line 65: @@
 !Valsalva (↓ Preload)
 !Release Valsalva
+!Left Lateral Decubitus
+!Learning Forward
+!Supine
 |-
+|Innocent
-|Flow murmur
-|
+|LSB
+|±apex
-|
 |mid-systolic
+|musical, vibratory
 |
 |
 |
 |
+|↓
 |
 |
 |
+|↑
 |-
 |[[Aortic regurgitation]]
-|LLSB
+|LLSB or PMI
+|±LUSB
-|
 |diastolic
 |blowing
@@ Line 86: / Line 95: @@
 |
 |↑
+|
+|↑
+|
 |-
-|Aortic regurgitation, Austin Flint
+|↳[[Austin Flint murmur|Austin Flint]]
 |PMI
 |
 |mid-diastolic
 |rumble
+|
+|
+|
 |
 |
@@ Line 102: / Line 117: @@
 |RUSB
 |±carotids
-|systolic
+|mid-systolic
 |
 |C-D
@@ Line 110: / Line 125: @@
 |↓
 |↑
+|
+|↑
+|
 |-
 |[[Mitral regurgitation]]
 |PMI
-|±axillae
+|±left axilla
+|holosystolic
-|systolic
 |
 |
@@ Line 121: / Line 139: @@
 |↑
 |↓
+|
+|↑
+|
 |
 |-
 |[[Mitral valve prolapse]]
-|
+|PMI
 |
 |early systolic
@@ Line 133: / Line 154: @@
 |↓
 |↑
+|
+|
+|
 |
 |-
@@ Line 138: / Line 162: @@
 |PMI
 |
-|diastolic
+|mid-diastolic
+|±OS, loud S1, rumble
-|
-|
+|D
 |↓
 |
 |↑
 |↓
+|
+|↑
+|
 |
 |-
@@ Line 158: / Line 185: @@
 |
 |↑
+|
+|
+|
 |-
 |[[Pulmonic stenosis]]
@@ Line 170: / Line 200: @@
 |
 |↑
+|
+|
+|
 |-
 |[[Tricuspid regurgitation]]
@@ Line 178: / Line 211: @@
 |
 |↑
+|
+|
+|
 |
 |
@@ Line 194: / Line 230: @@
 |↓
 |↓
+|
+|
+|
 |-
 |[[Atrial septal defect]]
@@ Line 200: / Line 239: @@
 |
 |may be harsh; fixed split S2
+|
+|
+|
 |
 |
@@ Line 210: / Line 252: @@
 |PMI
 |
+|holosystolic
-|
+|loud, high-pitched, harsh
-|
 |
 |
@@ Line 217: / Line 259: @@
 |
 |↓
+|
+|
+|
 |
 |-
@@ Line 222: / Line 267: @@
 |PMI to LLSB
 |
-|systolic
+|mid-systolic
+|harsh
-|
-|
+|C-D
 |
 |↓
 |↓
 |↑
+|
+|
+|
 |
 |-
@@ Line 236: / Line 284: @@
 |continuous
 |machine-like
+|
+|
+|
 |
 |