Murmur: Difference between revisions
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=== Location === |
=== Location === |
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− | * Aortic valve: second intercostal space at the right sternal border |
+ | * Aortic valve/right upper sternal border: second intercostal space at the right sternal border |
− | * Pulmonary valve: second intercostal space at the left sternal border |
+ | * Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border |
− | * Tricuspid valve: fourth intercostal space at the left sternal border |
+ | * Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border |
− | * Mitral valve: fifth intercostal space at the left midclavicular line |
+ | * Mitral valve/point of maximal impulse/apex: approximately the fifth intercostal space at the left midclavicular line |
+ | * Radiation |
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− | * Radiation: Murmurs may radiate, allowing auscultation at remote locations |
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===Intensity=== |
===Intensity=== |
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== Interpretation == |
== Interpretation == |
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− | {| class="wikitable" |
+ | {| class="wikitable sortable mw-collapsible" |
+ | ! rowspan="2" |Valvulopathy |
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⚫ | |||
+ | ! colspan="5" |Description |
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− | ! |
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+ | ! colspan="5" |Maneuvers |
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+ | ! colspan="3" |Position |
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⚫ | |||
!Location |
!Location |
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!Radiation |
!Radiation |
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!Valsalva (↓ Preload) |
!Valsalva (↓ Preload) |
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!Release Valsalva |
!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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− | |Flow murmur |
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− | | |
+ | |LSB |
+ | |±apex |
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⚫ | |||
|mid-systolic |
|mid-systolic |
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+ | |musical, vibratory |
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+ | |↓ |
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+ | |↑ |
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|- |
|- |
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|[[Aortic regurgitation]] |
|[[Aortic regurgitation]] |
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− | |LLSB |
+ | |LLSB or PMI |
+ | |±LUSB |
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⚫ | |||
|diastolic |
|diastolic |
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|blowing |
|blowing |
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|↑ |
|↑ |
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⚫ | |||
+ | |↑ |
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⚫ | |||
|- |
|- |
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− | | |
+ | |↳[[Austin Flint murmur|Austin Flint]] |
|PMI |
|PMI |
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|mid-diastolic |
|mid-diastolic |
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|rumble |
|rumble |
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⚫ | |||
⚫ | |||
⚫ | |||
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|RUSB |
|RUSB |
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|±carotids |
|±carotids |
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− | |systolic |
+ | |mid-systolic |
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|C-D |
|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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|[[Mitral regurgitation]] |
|[[Mitral regurgitation]] |
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|PMI |
|PMI |
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− | |± |
+ | |±left axilla |
+ | |holosystolic |
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− | |systolic |
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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]] |
|[[Mitral valve prolapse]] |
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− | | |
+ | |PMI |
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|early systolic |
|early systolic |
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|↓ |
|↓ |
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|↑ |
|↑ |
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+ | | |
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+ | | |
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+ | | |
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|PMI |
|PMI |
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− | |diastolic |
+ | |mid-diastolic |
+ | |±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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+ | |↑ |
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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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|[[Pulmonic stenosis]] |
|[[Pulmonic stenosis]] |
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|↑ |
|↑ |
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+ | | |
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+ | | |
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+ | | |
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|- |
|- |
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|[[Tricuspid regurgitation]] |
|[[Tricuspid 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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|↓ |
|↓ |
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+ | | |
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+ | | |
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+ | | |
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|- |
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|[[Atrial septal defect]] |
|[[Atrial septal defect]] |
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|may be harsh; fixed split S2 |
|may be harsh; fixed split S2 |
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+ | | |
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+ | | |
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+ | | |
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Line 210: | Line 252: | ||
|PMI |
|PMI |
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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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Line 222: | Line 267: | ||
|PMI to LLSB |
|PMI to LLSB |
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− | |systolic |
+ | |mid-systolic |
+ | |harsh |
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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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|continuous |
|continuous |
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|machine-like |
|machine-like |
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+ | | |
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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 |