Murmurs

 Caused by turbulent flow within heart and great vessels.

Timing Reason Lesion
Pansystolic Occurs when the ventricle leaks Mitral regurgitation
to a lower pressure chamber or Tricuspid regurgitation
vessel VSD
Aortopulmonary shunts
Mid systolic / ejection Caused by turbulent flow Aortic stenosis
systolic through aortic/pulmonary Pulmonary stenosis
valve orifices or increased flow Hypertrophic cardiomyopathy
through a normal orifice Pulmonary flow murmur of
ASD
Late systolic Mitral valve prolapse
Papillary muscle dysfunction
Early diastolic High-pitched and due to Aortic regurgitation
regurgitation through Pulmonary regurgitation
aortic/pulmonary valves
Mid diastolic Due to impaired flow during Mitral stenosis
ventricular filling Tricuspid stenosis
Atrial myxoma
Austin Flint murmur of aortic
Regurgitation
Carey Coombs murmur of acute
rheumatic fever
Presystolic Extensions of mid diastolic Mitral stenosis
murmurs Tricuspid stenosis
Atrial myxoma
Continuous Produced when a PDA
communication exists between AV fistula
2 parts of the circulation with a Aortopulmonary connection
permanent pressure gradient. Venous hum
Rupture of sinus of Valsalva into
rt ventricle/atrium

 Loudness – depends of the degree of turbulence. Does not always indicate severity.
Levine’s grading system : grade 1/6 – very soft, not heard at first
grade 2/6 – soft, but can be detected
grade 3/6 – moderate, but no thrills
grade 4/6 – loud, thrill just palpable
grade 5/6 – very loud, thrill easily palpable
grade 6/6 – very, very loud, can be heard without placing
stethoscope

 Pitch/quality – can be low, medium or high pitched

 Location or area of greatest intensity – the area where the murmur helps to identify the ara of
lesion and aid in the diagnosis
 Radiation – aortic stenosis radiates to the neck, mitral regurgitation radiates to the axilla while
aortic regurgitation radiates to the left sterna edge.