heart murmurs made easy

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Murmurs are described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation, and response to dynamic maneuvers

timing


A murmur is either systolic, diastolic, or continuous throughout systole and diastole.

grading

Shape

The shape of a murmur describes the change of intensity throughout the cardiac cycle. Murmurs are either crescendo, decrescendo, crescendo-decrescendo, or uniform.

Pitch

A murmur will be high pitched if there is a large pressure gradient across the pathologic lesion and low pitched if the pressure gradient is low. For example, the murmur of aortic stenosis is high pitched since there is usually a large pressure gradient between the LV and the aorta. Conversely, the murmur of mitral stenosis is low pitched since there is a lower pressure gradient between the LA and the LV during diastole. Remember high pitched sounds are heard with the diaphragm of the stethoscope while low pitched sounds are heard with the bell.


location
In general, a murmur will be the most intense over whichever listening post corresponds to the diseased valve. Many murmurs will radiate to more than one listening post. For example, the murmur of aortic stenosis is best heard at the LUSB, however it may radiate to the apex. This radiation of the AS murmur is called the "Gallavardin dissociation".

Radiation

While murmurs are usually most intense at one specific listening post, they often radiate to other listening posts or areas of the body. For example, the murmur of aortic stenosis frequently radiates to the carotid arteries and the murmur of mitral regurgitation radiates to the left axillary region. It is often difficult to distinguish if one murmur is radiating to multiple sites or if there are multiple murmurs present from many different causes. Dynamic auscultation and echocardiography is helpful in determining the exact lesion present.


Overview of heart murmur
systolic murmur
diastolic murmur
dynamic auscultation




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