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 |
