II. 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

III. 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

IV. Resources

  1. University of Michigan Heart Sound and Murmur Library
    1. http://www.med.umich.edu/lrc/psb/heartsounds/

Images: Related links to external sites (from Google)

Ontology: Heart murmur (C0018808)

Definition (NCI) A periodic humming or blowing sound heard on auscultation of the heart that can indicate the presence of cardiac disease; murmurs are the result of vibrations caused by the turbulent flow of blood in the heart or great vessels. Murmurs are characterized according to the area of generation (mitral, aortic, tricuspid, or pulmonary) and according to the period of the cycle (systolic or diastolic).
Definition (MSH) Heart sounds caused by vibrations resulting from the flow of blood through the heart. Heart murmurs can be examined by HEART AUSCULTATION, and analyzed by their intensity (6 grades), duration, timing (systolic, diastolic, or continuous), location, transmission, and quality (musical, vibratory, blowing, etc).
Concepts Finding (T033)
MSH D006337
ICD10 R01.1
SnomedCT 421493004, 274249001, 288315006, 88610006, 158342004, 158337007, 301129009, 414786004
English Cardiac murmur, Cardiac Murmurs, Heart Murmurs, Murmur, Cardiac, Murmur, Heart, Murmurs, Cardiac, Murmurs, Heart, Cardiac Murmur, Cardiac murmur, NOS, HEART MURMUR, Heart murmur, NOS, MURMUR, Murmur, NOS, Cardiac murmur, unspecified, Heart murmur NOS, [D]Heart murmur (context-dependent category), [D]Heart murmur NOS (context-dependent category), Heart murmur (observable entity), Heart murmur [D], [D]Heart murmur NOS, heart murmur on auscultation (physical finding), heart murmur, heart murmur on auscultation, murmurs, [D]Heart murmur NOS (situation), Heart murmur [D] (situation), Cardiac murmur NOS, Heart murmurs, [D]Heart murmur, [D]Heart murmur (situation), Heart Murmur, Murmur, Cardiac Murmur, Heart Murmurs [Disease/Finding], Murmur;cardiac, murmuring, cardiac murmurs, heart murmuring, heart murmurs, Observation of heart murmur, Finding of heart murmur, Heart murmur (finding), Heart/arterial murmur nos, heart valve; murmur, heart; murmur, murmur; heart, murmur, Finding of heart murmur (finding), Heart murmur [D] (finding), Heart murmur, Murmur, Murmur (finding), cardiac murmur
German HERZGERAEUSCHE, Herzgeraeusch NNB, Herzgeraeusch, nicht naeher bezeichnet, Herzgeraeusch, Herzgeräusche
Italian Soffio cardiaco, Soffio cardiaco NAS, Soffi cardiaci NSA, Soffi al cuore, Soffi cardiaci
Spanish soplo cardíaco, soplo cardíaco (entidad observable), Soplo cardiaco NEOM, [D]soplo cardíaco, SAI (categoría dependiente del contexto), soplo cardíaco (categoría dependiente del contexto), [D]Heart murmur NOS, Heart murmur [D], SOPLO CARDIACO, Soplo cardiaco, NE, [D]soplo cardíaco, SAI, murmullo, soplo cardíaco (hallazgo), soplos cardíacos (hallazgo), murmullo cardíaco, [D]soplo cardíaco, SAI (situación), soplos cardíacos, soplo cardíaco (situación), hallazgo de soplo (hallazgo), hallazgo de soplo, soplo del corazón, Soplo cardiaco, soplo (hallazgo), soplo, Soplos Cardíacos, Soplos Cardiacos
Dutch hartgeruis NAO, Hartgeruis NAO, Hartgeruis/vaatgeruis nao, geruis; hart, hart; geruis, hartklep; geruis, Hartgeruis, niet gespecificeerd, hartgeruis, Geruis, hart-, Hartgeruis
French Souffle cardiaque SAI, Souffle au coeur, Souffles cardiaques, Souffle du coeur, Souffle cardiaque, SOUFFLE CARDIAQUE, Souffle cardiaque NP, Murmure cardiaque
Portuguese Sopro cardíaco NE, SONS CARDIACOS, Sopro cardiaco NE, Sopro cardíaco, Sopros Cardíacos
Japanese 心雑音NOS, シンザツオンNOS, シンザツオン, 心雑音
Swedish Blåsljud, HJARTBILJUD UNS
Czech srdce - šelesty, Srdeční šelest NOS, Srdeční šelest
Finnish Sydämen sivuäänet, SIVUAANI SYDAMESSA NUD
Russian SERDTSA SHUMY, СЕРДЦА ШУМЫ
Norwegian HJERTE FREMMED-/BILYDER INA
Danish Hjertemislyd INA
Hungarian sziv-zorej (nem meghat.), Szívzörej k.m.n., Szívzörej
Korean 상세불명의 심장잡음
Basque BIHOTZ PUTZALDIA EZ
Hebrew ivsha balev
Polish Szmery serca