Murmurs
Murmurs should be described using the following characteristics:
- Pitch - High, medium, low
- Quality - Blowing, harsh, rumbling, musical
- Radiation - Across the precordium, into the right 2nd intercostal space, axillae, into carotids
- Shape - Crescendo, decrescendo, crescendo-decrescendo, plateau
- Timing - Systolic, diastolic, continuous
- Intensity - On a graded scale from 1-6
- Location - Across the precordium
Common Murmurs:
- Systolic murmurs
- Mid-systolic - Innocent and physiologic murmurs
- Pan/holo-systolic - Aortic stenosis most commonly, also mitral and tricuspid regurgitation, ventricular septal defect
- Late-systolic - Mitral valve prolpase
- Diastolic murmurs
- Early diastolic - Aortic regurgitation
- Mid-diastolic - Mitral or tricuspid stenosis
Shape of Murmurs:
Crescendo murmur (e.g. mitral stenosis)

Decrescendo murmur (e.g. aortic regurgitation)

Crescendo-descrescendo murmur (e.g. aortic stenosis)

Plateau murmur (e.g. mitral regurgitation)
Gradation of Murmurs:
1/6 Faint – not immediately heard, no thrill
2/6 Faint – immediately heard, no thrill
3/6 Moderately loud - no thrill
4/6 Moderately loud - thrill palpable
5/6 Loud - can hear with stethoscope partially off chest wall, thrill palpable
6/6 Loud - heard without a stethoscope, thrill palpable