Heart murmur classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Timing of Murmur
The timing of heart murmurs can be broadly classified as either diastolic or systolic [1].
- Diastolic heart murmurs are not normal, while systolic heart murmurs may be normal or abnormal,
- Diastolic murmurs always require further evaluation,
- Systolic murmurs are most often benign, and are due to rapid flow rates,
- Systolic murmurs are not normal when accompanied by a heave.
Intensity of Murmur
Grading the loudness of a murmur from 1 to 6 is a well described and widely used method [2]
| Gradations of Murmurs | Description |
| Grade 1 | Very faint, heard only after listener has "tuned in"; may not be heard in all positions. |
| Grade 2 | Quiet, but heard immediately after placing the stethoscope on the chest. |
| Grade 3 | Moderately loud. |
| Grade 4 | Murmur is very loud, with palpable thrill. |
| Grade 5 | Murmur is extremely loud, with palpable thrill, and can be heard if only the edge of the stethoscope is in contact with the skin, but cannot be heard if the stethoscope is removed from the skin. |
| Grade 6 | Murmur is exceptionally loud, with palpable thrill, and can be heard with the stethoscope just removed from contact with the chest. |
Systolic thrills usually are associated with murmurs of grade 4 or louder. Systolic murmurs of grade 3 or more in intensity are usually hemodynamically significant. [3]
References
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:104-105 ISBN 140510368X
- ↑ Freeman AR, Levine SA. Clinical significance of systolic murmurs: study of 1000 consecutive "noncardiac" cases. Ann Intern Med. 1933, 6: 1371–85.
- ↑ Norton P, O'Rourke RA. Cardiac murmurs (Goldman L, Braunwald E, eds. Cardiology for the Primary Physician). 2nd ed. Philadelphia PA Saunders, 2003: 151-68