Murmur: Difference between revisions

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=== Location ===
  
=== Location ===
   
βˆ’
* Aortic valve: second intercostal space at the right sternal border
 +
* Aortic valve/right upper sternal border: second intercostal space at the right sternal border
βˆ’
* Pulmonary valve: second intercostal space at the left sternal border
 +
* Pulmonary valve/left upper sternal border: second intercostal space at the left sternal border
βˆ’
* Tricuspid valve: fourth intercostal space at the left sternal border
 +
* Tricuspid valve/left lower sternal border: fourth intercostal space at the left sternal border
βˆ’
* 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
βˆ’
* Radiation: Murmurs may radiate, allowing auscultation at remote locations
  
   
 
===Intensity===
  
===Intensity===
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== Interpretation ==
  
== Interpretation ==
βˆ’
{| class="wikitable"
 +
{| class="wikitable sortable mw-collapsible"
  ⚫
! rowspan="2" |Valvulopathy
⚫
|+
  
  +
! colspan="5" |Description
⚫
!Valvulopathy
  
  +
! colspan="5" |Maneuvers
  +
! colspan="3" |Position
  ⚫
|-
 
!Location
  
!Location
 
!Radiation
  
!Radiation
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!Valsalva (↓ Preload)
  
!Valsalva (↓ Preload)
 
!Release Valsalva
  
!Release Valsalva
  +
!Left Lateral Decubitus
  +
!Learning Forward
  +
!Supine
 
|-
  
|-
  +
|Innocent
βˆ’
|Flow murmur
  
βˆ’
|
 +
|LSB
  +
|Β±apex
⚫
|
  
 
|mid-systolic
  
|mid-systolic
  +
|musical, vibratory
 
|
  
|
 
|
  
|
 
|
  
|
 
|
  
|
  +
|↓
 
|
  
|
 
|
  
|
 
|
  
|
  +
|↑
 
|-
  
|-
 
|[[Aortic regurgitation]]
  
|[[Aortic regurgitation]]
βˆ’
|LLSB
 +
|LLSB or PMI
  +
|Β±LUSB
⚫
|
  
 
|diastolic
  
|diastolic
 
|blowing
  
|blowing
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|
  
|
 
|↑
  
|↑
  ⚫
|
  +
|↑
  ⚫
|
 
|-
  
|-
βˆ’
|Aortic regurgitation, Austin Flint
 +
|↳[[Austin Flint murmur|Austin Flint]]
 
|PMI
  
|PMI
 
|
  
|
 
|mid-diastolic
  
|mid-diastolic
 
|rumble
  
|rumble
  ⚫
|
  ⚫
|
  ⚫
|
 
|
  
|
 
|
  
|
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|RUSB
  
|RUSB
 
|Β±carotids
  
|Β±carotids
βˆ’
|systolic
 +
|mid-systolic
 
|
  
|
 
|C-D
  
|C-D
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|↓
  
|↓
 
|↑
  
|↑
  ⚫
|
  +
|↑
  +
|
 
|-
  
|-
 
|[[Mitral regurgitation]]
  
|[[Mitral regurgitation]]
 
|PMI
  
|PMI
βˆ’
|Β±axillae
 +
|Β±left axilla
  +
|holosystolic
βˆ’
|systolic
  
 
|
  
|
 
|
  
|
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|↑
  
|↑
 
|↓
  
|↓
  +
|
  +
|↑
  +
|
 
|
  
|
 
|-
  
|-
 
|[[Mitral valve prolapse]]
  
|[[Mitral valve prolapse]]
βˆ’
|
 +
|PMI
 
|
  
|
 
|early systolic
  
|early systolic
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|↓
  
|↓
 
|↑
  
|↑
  +
|
  +
|
  +
|
 
|
  
|
 
|-
  
|-
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|PMI
  
|PMI
 
|
  
|
βˆ’
|diastolic
 +
|mid-diastolic
  +
|Β±OS, loud S1, rumble
⚫
|
  
βˆ’
|
 +
|D
 
|↓
  
|↓
 
|
  
|
 
|↑
  
|↑
 
|↓
  
|↓
  +
|
  +
|↑
  +
|
 
|
  
|
 
|-
  
|-
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|
  
|
 
|↑
  
|↑
  +
|
  +
|
  +
|
 
|-
  
|-
 
|[[Pulmonic stenosis]]
  
|[[Pulmonic stenosis]]
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|
  
|
 
|↑
  
|↑
  +
|
  +
|
  +
|
 
|-
  
|-
 
|[[Tricuspid regurgitation]]
  
|[[Tricuspid regurgitation]]
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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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|PMI
  
|PMI
 
|
  
|
  +
|holosystolic
⚫
|
  
  +
|loud, high-pitched, harsh
⚫
|
  
 
|
  
|
 
|
  
|
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|
  
|
 
|↓
  
|↓
  +
|
  +
|
  +
|
 
|
  
|
 
|-
  
|-
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|PMI to LLSB
  
|PMI to LLSB
 
|
  
|
βˆ’
|systolic
 +
|mid-systolic
  +
|harsh
⚫
|
  
βˆ’
|
 +
|C-D
 
|
  
|
 
|↓
  
|↓
 
|↓
  
|↓
 
|↑
  
|↑
  +
|
  +
|
  +
|
 
|
  
|
 
|-
  
|-
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|continuous
  
|continuous
 
|machine-like
  
|machine-like
  +
|
  +
|
  +
|
 
|
  
|
 
|
  
|

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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