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 | ||||||||||
