Systolic murmurs are easiest to hear, but it is more difficult to decide what type they are
Don’t forget to feel for the carotid to know whether they are systolic or diastolic!
- Systole – between S1 and S2
- Diastole – between S2 and S3
Left sided murmurs are best heard on Expiration
Right sided heart murmurs are best heard on Inspiration
Left sided murmurs are more clinically severe!
Infective Endocarditis can cause any murmur, but is most likely to cause regurgitation.
Connective tissue disorders (e.g. ankylosing spondylitis, rheumatoid arthritis, SLE, Marfan’s syndrome) can all cause valve defects. This occurs because the valve annulus (the ring of connective tissue that holds the valve cusps in place) may be affected, and is not longer able to properly support the valves.
Eponymous signs of aortic regurgitation
Name | Sign |
Austin Flint Murmur | Mid-diastolic murmur in the absence of mitral stenosis |
Becker Sign | Accentuated Retinal Artery Pulsation |
Corrigan’s Sign | Collapsing pulse (aka ‘WaterHammer pulse’) |
De Musset sign | Head bobbing in time with the heart beat |
Duroziez sign | Femoral artery sounds under compression |
Gerhard Sign | Pulsatile spleen |
Hill Sign | Higher systolic BP in the legs than in the arms |
Mayne Sign | Drop in systolic BP >15mmHg when arm is raised |
Mueller sign | Pulsatile uvula |
Quincke sign | Exaggerated nailbed pulsations |
Rosenback sign | Pulsatile Liver |
Traube Sign | Loud sounds heard in systole and diastole over the femoral artery. Sometimes described as a pistol shot – heard with light compression |
Grading Murmurs
If you hear a murmur you should be able to describe:
- Systolic / Pansystolic
- Duration – e.g. pan-systolic, ejection systolic
- Site best heard at – e.g. Mitral area
- Radiation – e.g. axilla
- Grade
Murmurs can be graded on a scale of 1 – 6:
Grade | Description | Thrill |
1 | Very faint, can only be heard with stethoscope under optimal conditions | No |
2 | Only heard with stethoscope, but easily audible | No |
3 | Still only heard through the stethoscope, but loud | No |
4 | Similar to Grade 3, but also palpable | YES |
5 | Louder than grade 4, and palpable thrill | YES |
6 | Audible without the use of a stethoscope, and palpable thrill | YES |
Whats the difference between a thrill and a heave?
- A thrill - is a palpable murmur
- A heave - is the result of LVH (Left ventricular hypertrophy) and feel liks something pushing your hand off the chest
Notes by Tom Leach
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