Murmur: Difference between revisions

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==Grading==
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== Description ==
  +
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=== Location ===
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* Aortic valve/right upper sternal border: second intercostal space at the right sternal border
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* 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
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  +
===Intensity===
 
{| class="wikitable"
  
{| class="wikitable"
 
!Grade
  
!Grade
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|}
  
|}
   
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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 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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|-
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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 (↑ 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
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!Supine
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|-
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|Innocent
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|LSB
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|Β±apex
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|mid-systolic
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|musical, vibratory
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|
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|
  +
|
  +
|
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|↓
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|
  +
|
  +
|
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|↑
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|-
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|[[Aortic regurgitation]]
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|LLSB or PMI
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|Β±LUSB
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|diastolic
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|blowing
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|D
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|↓
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|↑
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|↑
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|
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|↑
  +
|
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|↑
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|
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|-
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|↳[[Austin Flint murmur|Austin Flint]]
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|PMI
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|
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|mid-diastolic
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|rumble
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|
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|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
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|-
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|[[Aortic stenosis]]
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|RUSB
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|Β±carotids
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|mid-systolic
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|
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|C-D
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|↓
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|
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|↑
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|↓
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|↑
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|
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|↑
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|
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|-
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|[[Mitral regurgitation]]
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|PMI
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|Β±left axilla
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|holosystolic
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|
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|
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|↓
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|↑
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|↑
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|↓
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|
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|↑
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|
  +
|
  +
|-
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|[[Mitral valve prolapse]]
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|PMI
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|
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|early systolic
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|click
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|
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|↓
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|↓
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|↓
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|↑
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|
  +
|
  +
|
  +
|
  +
|-
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|[[Mitral stenosis]]
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|PMI
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|
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|mid-diastolic
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|Β±OS, loud S1, rumble
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|D
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|↓
  +
|
  +
|↑
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|↓
  +
|
  +
|↑
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|
  +
|
  +
|-
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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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|
  +
|
  +
|
  +
|-
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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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|↑
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|
  +
|
  +
|
  +
|↑
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|
  +
|
  +
|
  +
|-
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|[[Tricuspid regurgitation]]
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|LLSB
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|
  +
|systolic
  +
|
  +
|
  +
|↑
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|-
  +
|[[Tricuspid stenosis]]
  +
|LLSB
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|
  +
|diastolic
  +
|
  +
|
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|↑
  +
|
  +
|
  +
|↓
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|↓
  +
|
  +
|
  +
|
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|-
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|[[Atrial septal defect]]
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|LUSB
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|
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|
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|may be harsh; fixed split S2
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|
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|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
  +
|
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|-
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|[[Ventricular septal defect]]
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|PMI
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|
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|holosystolic
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|loud, high-pitched, harsh
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|
  +
|
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|↑
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|
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|↓
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|
  +
|
  +
|
  +
|
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|-
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|[[Hypertrophic obstructive cardiomyopathy]]
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|PMI to LLSB
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|
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|mid-systolic
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|harsh
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|C-D
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|
  +
|↓
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|↓
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|↑
  +
|
  +
|
  +
|
  +
|
  +
|-
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|[[Patent ductus arteriosus]]
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|LUSB
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|
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|continuous
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|machine-like
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|
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|
  +
|
  +
|
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|
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|
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|
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|
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|
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|}
 
[[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 Β±apex mid-systolic musical, vibratory ↓ ↑
Aortic regurgitation LLSB or PMI Β±LUSB diastolic blowing D ↓ ↑ ↑ ↑ ↑
↳Austin Flint PMI mid-diastolic rumble
Aortic stenosis RUSB Β±carotids mid-systolic C-D ↓ ↑ ↓ ↑ ↑
Mitral regurgitation PMI Β±left axilla holosystolic ↓ ↑ ↑ ↓ ↑
Mitral valve prolapse PMI early systolic click ↓ ↓ ↓ ↑
Mitral stenosis PMI mid-diastolic Β±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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