Heart Murmur Grading Flashcards

Heart Murmur Grading

• Grade 1: Murmur only audible after careful listening.
• Grade 2: Faint murmur immediately audible upon stethoscope placement.
• Grade 3: Loud murmur clearly audible but without palpable thrill.
• Grade 4: Loud murmur present with a palpable thrill.
• Grade 5: Loud murmur with palpable thrill; audible with only the rim of the stethoscope touching the chest.
• Grade 6: Loud murmur with a palpable thrill; audible even when the stethoscope is lifted slightly off the chest.

Definitions of Key Terms

• Thrill: Vibration felt on the skin surface due to turbulent blood flow.
• Murmur: Turbulent blood flow through heart valves or abnormal structures, detected via auscultation.
• Bruit: Turbulent blood flow audible in peripheral vessels upon auscultation.

Murmur Descriptive System (TIPPQRS)

• Timing: Identified as either systolic or diastolic.
• Intensity: Generally grade 2 for quiet murmurs and grade 3 for loud; grade 1 implies expertise.
• Position (P1): Area on the precordium where murmur is loudest.
• Position (P2): Patient's position when murmur is loudest, mainly for diastolic murmurs.
• Quality: Characteristics can include high-pitched, crescendo-decrescendo, or breath-like.
• Radiation: Assessment of whether the murmur radiates to areas like the carotids or axilla.
• Systemic Features: Consideration of other heart sounds, apex beat, and pulse characteristics.

Specific Murmurs

• Aortic Regurgitation:

  • Diastolic murmur.
  • Apex displacement laterally/anteriorly.
  • Palpable thrill along left sternal border and jugular notch.
  • Double systolic wave in carotids.

• Aortic Regurgitation Quality:

  • Decrescendo diastolic murmur along the left sternal border; M1 and A2 increased.

• Aortic Stenosis:

  • Systolic murmur.
  • Basal systolic thrill; apex displaced anteriorly/laterally.
  • Radiates to carotid artery.

• Aortic Stenosis Quality:

  • Starts quietly, crescendos mid-systole, then quiets toward end of systole.

• Mitral Regurgitation:

  • Systolic murmur.
  • Apical systolic thrill; apex displaced left.

• Mitral Regurgitation Quality:

  • Apical systolic regurgitant murmur; follows decreased S1, radiates to axilla; notable S2 due to increased left ventricular end diastolic volume.

• Mitral Valve Prolapse:

  • Common in women under 30; characterized by mid/late systolic click 0.14 seconds post S1, followed by high-pitched systolic murmur; squatting may decrease murmur.

• Mitral Stenosis:

  • Diastolic murmur.
  • Tapping apex beat; diastolic thrill at apex; parasternal lift.

• Mitral Stenosis Quality:

  • Loud S1 - S2; diastolic snap followed by rumble; potential atrial fibrillation; cold extremities.

• Tricuspid Regurgitation:

  • Systolic murmur; usually secondary to another cardiac pathology.
  • Right ventricular parasternal lift; systolic thrill at tricuspid area.

• Tricuspid Regurgitation Quality:

  • Holosystolic murmur that increases with inspiration; V wave in jugular venous pulse; systolic liver pulsation.