? Heart murmurs are abnormal sounds produced by
turbulent flow across an abnormal valve, septal
defect or outflow obstruction.
How to assess?
? Timing
? Character & pitch
? Intensity
? Location
? Radiation
Timing
? Identify S1 & S2
? Palpate carotid pulsation
? Determine whether the murmur is systolic or
diastolic.
Duration
? Pansystolic
? Late systolic
? Ejection systolic
? Early diastolic
Character & pitch
? Harsh
? musical
? Rumbling
? subjective
? aortic regurgitation > mitral stenosis
Intensity
? Grade 1- very soft (heard by an expert under
? Grade 2- soft (non expert under optimum)
? Grade 3- moderate, easily heard, no thrill
? Grade 4- loud, with thrill
? Grade 5- very loud
? Diastolic murmurs are rarely louder than grade 4
? Intensity has no relation with severity.
? Severe aortic stenosis - inaudible murmur
? Change in intensity with time is imp.
Location
? Record the sites where murmur is best heard
? Apex
? Right & left upper sternal edge
? Helps to differentiate diastolic murmurs
? Mitral stenosis - apex
? Aortic regurgitation- left sternal edge
Radiation
? mitral regurg. Left axilla
? ventricular septal defect- Right sternal edge
? aortic stenosis- sulra sternal notch & carotid
arteries
Innocent/ Benign murmurs
? Increased velocity of flow
? normal valve
? Increased stroke volume
? Pregnant women, athletes with resting bradycardia,
? Soft, mid systolic, heard at left sternal edge
? No radiation
turbulent flow across an abnormal valve, septal
defect or outflow obstruction.
How to assess?
? Timing
--- Content provided by FirstRanker.com ---
? Duration? Character & pitch
? Intensity
? Location
? Radiation
--- Content provided by FirstRanker.com ---
Timing
? Identify S1 & S2
? Palpate carotid pulsation
? Determine whether the murmur is systolic or
diastolic.
--- Content provided by FirstRanker.com ---
Duration
? Pansystolic
? Late systolic
? Ejection systolic
? Early diastolic
--- Content provided by FirstRanker.com ---
? mid diastolicCharacter & pitch
? Harsh
? musical
? Rumbling
--- Content provided by FirstRanker.com ---
? high/low pitched? subjective
? aortic regurgitation > mitral stenosis
Intensity
? Grade 1- very soft (heard by an expert under
--- Content provided by FirstRanker.com ---
optimum conditions)? Grade 2- soft (non expert under optimum)
? Grade 3- moderate, easily heard, no thrill
? Grade 4- loud, with thrill
? Grade 5- very loud
--- Content provided by FirstRanker.com ---
? Grade 6- heard without stethescope? Diastolic murmurs are rarely louder than grade 4
? Intensity has no relation with severity.
? Severe aortic stenosis - inaudible murmur
? Change in intensity with time is imp.
--- Content provided by FirstRanker.com ---
? Rapidly changing murmur- inf endocarditisLocation
? Record the sites where murmur is best heard
? Apex
? Right & left upper sternal edge
--- Content provided by FirstRanker.com ---
? lower left sternal edge? Helps to differentiate diastolic murmurs
? Mitral stenosis - apex
? Aortic regurgitation- left sternal edge
Radiation
--- Content provided by FirstRanker.com ---
? Direction of blood flow outside precordium? mitral regurg. Left axilla
? ventricular septal defect- Right sternal edge
? aortic stenosis- sulra sternal notch & carotid
arteries
--- Content provided by FirstRanker.com ---
Innocent/ Benign murmurs
? Increased velocity of flow
? normal valve
? Increased stroke volume
? Pregnant women, athletes with resting bradycardia,
--- Content provided by FirstRanker.com ---
patients with fever? Soft, mid systolic, heard at left sternal edge
? No radiation