Murmur: Difference between revisions

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(Created page with "==Grading== {| | Grade | Description |- | Grade 1 | Faintest sound that can be detected |- | Grade 2 | Soft murmur that is readily detectable |- | Grade 3 | Louder than grad...")
 
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==Grading==
 +
== Description ==
  +
−
{|
  
  +
=== Location ===
−
| Grade | Description
  
  +
  +
* 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===
  +
{| class="wikitable"
  +
!Grade
  +
!Description
 
|-
  
|-
  +
|Grade 1
−
| Grade 1 | Faintest sound that can be detected
  
  +
|Faintest sound that can be detected
 
|-
  
|-
  +
|Grade 2
−
| Grade 2 | Soft murmur that is readily detectable
  
  +
|Soft murmur that is readily detectable
 
|-
  
|-
  +
|Grade 3
−
| Grade 3 | Louder than grade 2 but not associated with a palpable thrill
  
  +
|Louder than grade 2 but not associated with a palpable thrill
 
|-
  
|-
  +
|Grade 4
−
| Grade 4 | Associated with a palpable thrill
  
  +
|Associated with a palpable thrill
 
|-
  
|-
  +
|Grade 5
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| Grade 5 | Audible with stethoscope placed lightly on the chest
  
  +
|Audible with stethoscope placed lightly on the chest
 
|-
  
|-
  +
|Grade 6
−
| Grade 6 | Audible with stethoscope off the chest
  
  +
|Audible with stethoscope off the chest
 
|}
  
|}
   
  +
=== Quality ===
  +
  +
* 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
  +
  +
=== Timing ===
  +
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* Systolic, diastolic
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* Early, mid, or late
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* Holosystolic
  +
  +
== Interpretation ==
  +
{| class="wikitable sortable mw-collapsible"
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! rowspan="2" |Valvulopathy
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! colspan="5" |Description
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! colspan="5" |Maneuvers
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! colspan="3" |Position
  +
|-
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!Location
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!Radiation
  +
!Timing
  +
!Quality
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!Profile
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!Inspiration
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!Isometric Handgrip (↑ Afterload)
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!Squatting (↑ Preload)
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!Valsalva (↓ Preload)
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!Release Valsalva
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!Left Lateral Decubitus
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!Learning Forward
  +
!Supine
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|-
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|Innocent
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|LSB
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|±apex
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|mid-systolic
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|musical, vibratory
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|
  +
|
  +
|
  +
|
  +
|↓
  +
|
  +
|
  +
|
  +
|↑
  +
|-
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|[[Aortic regurgitation]]
  +
|LLSB or PMI
  +
|±LUSB
  +
|diastolic
  +
|blowing
  +
|D
  +
|↓
  +
|↑
  +
|↑
  +
|
  +
|↑
  +
|
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|↑
  +
|
  +
|-
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|↳[[Austin Flint murmur|Austin Flint]]
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|PMI
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|
  +
|mid-diastolic
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|rumble
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|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Aortic stenosis]]
  +
|RUSB
  +
|±carotids
  +
|mid-systolic
  +
|
  +
|C-D
  +
|↓
  +
|
  +
|↑
  +
|↓
  +
|↑
  +
|
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|↑
  +
|
  +
|-
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|[[Mitral regurgitation]]
  +
|PMI
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|±left axilla
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|holosystolic
  +
|
  +
|
  +
|↓
  +
|↑
  +
|↑
  +
|↓
  +
|
  +
|↑
  +
|
  +
|
  +
|-
  +
|[[Mitral valve prolapse]]
  +
|PMI
  +
|
  +
|early systolic
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|click
  +
|
  +
|↓
  +
|↓
  +
|↓
  +
|↑
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Mitral stenosis]]
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|PMI
  +
|
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|mid-diastolic
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|±OS, loud S1, rumble
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|D
  +
|↓
  +
|
  +
|↑
  +
|↓
  +
|
  +
|↑
  +
|
  +
|
  +
|-
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|[[Pulmonic regurgitation]]
  +
|
  +
|
  +
|
  +
|
  +
|
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|↑
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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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|
  +
|systolic
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|
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|C-D
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|↑
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|
  +
|
  +
|
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|↑
  +
|
  +
|
  +
|
  +
|-
  +
|[[Tricuspid regurgitation]]
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|LLSB
  +
|
  +
|systolic
  +
|
  +
|
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|↑
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Tricuspid stenosis]]
  +
|LLSB
  +
|
  +
|diastolic
  +
|
  +
|
  +
|↑
  +
|
  +
|
  +
|↓
  +
|↓
  +
|
  +
|
  +
|
  +
|-
  +
|[[Atrial septal defect]]
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|LUSB
  +
|
  +
|
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|may be harsh; fixed split S2
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Ventricular septal defect]]
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|PMI
  +
|
  +
|holosystolic
  +
|loud, high-pitched, harsh
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|
  +
|
  +
|↑
  +
|
  +
|↓
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Hypertrophic obstructive cardiomyopathy]]
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|PMI to LLSB
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|
  +
|mid-systolic
  +
|harsh
  +
|C-D
  +
|
  +
|↓
  +
|↓
  +
|↑
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Patent ductus arteriosus]]
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|LUSB
  +
|
  +
|continuous
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|machine-like
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|}
 
[[Category:Clinical exam]]
  
[[Category:Clinical exam]]
 
[[Category:Cardiology]]
  
[[Category:Cardiology]]

Latest revision as of 13:33, 15 March 2022

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
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