Exam
Heart Murmur
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Heart Murmur
, Heart Murmur Interpretation
See Also
Systolic Murmur
Diastolic Murmur
Pediatric Murmur
Exam
Characteristics
Identify beginning of systole and diastole
S1 Heart Sound
S2 Heart Sound
Timing
Determine timing of murmur
Systolic Murmur
Diastolic Murmur
Determine Early, Middle or late in interval
Severity
Grade 1/6: Barely audible
Grade 2/6: Just easily audible
Grade 3/6:
Grade 4/6:
Grade 5/6: Loudest requiring a stethoscope
Grade 6/6: Heard with stethoscope off chest
Location
Identify valve area involved
Pattern
Uniform: Constant
Crescendo: Increasing
Decrescendo (Diminuendo): Decreasing
Crescendo-Decrescendo: Diamond Shaped Murmur
Pitch
Low pitched
Best heard with bell chest-piece at light pressure
High pitched
Best heard with diaphragm at firm pressure
Dynamic Maneuvers
Position
Supine
Erect
Left lateral decubitus position
Exercise
Interpretation
Benign murmur findings
Murmur characteristics
Crescendo-decrescend character
Musical or vibratory murmur
Quiet murmur (Grade 2 or less)
Timing: Early systolic or mid
Systolic Murmur
Location: Left sternal border or pulmonic area
Associated findings absent
Cardiopulmonary symptoms absent
Family History
absent
Exam (BP, pulse, auscultation) otherwise normal
Normal physiologic split S2 without gallup or click
Pathologic murmur findings
Murmur characteristics
Timing: Diastolic, mid-late systolic, holosystolic
Loud murmur (Grade 3 or greater)
Murmur exacerbated by
Valsalva Maneuver
Murmur radiates to
Carotid Artery
or axilla
Associated findings present
Arrhythmia
present
Symptoms:
Chest Pain
,
Palpitation
,
Dyspnea
,
Syncope
Sudden Cardiac Death
Family History
Jugular Venous Pulsation
abnormal
Arterial pulsation abnormal
Wide
Pulse Pressure
Water-Hammer Pulse
(rapidly rising, bounding)
Weak, slow rising pulse
Other abnormal precordial exam
Other heart sounds (e.g. Loud S1, fixed split S2)
Left ventricular heave
Resources
University of Michigan Heart Sound and Murmur Library
http://www.med.umich.edu/lrc/psb/heartsounds/
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