Exam

Heart Murmur

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Heart Murmur, Heart Murmur Interpretation

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