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Cardio Exam

Listening for Murmurs

July 1st, 2020


  • How to Assess

  • Auscultate while palpating the pulse (preferably the carotid). Identify whether the murmur is systolic (between S1 and S2), diastolic (between S2 and S1 of the next cardiac cycle) or continuous.
  • Interpretation

  • 1/6: The faintest murmur, audible with the most careful auscultation.
  • 2/6: A faint murmur that is easily heard.
  • 3/6: Prominent, louder than the heart sounds.
  • 4/6: A loud murmur, accompanied by a thrill.
  • 5/6: A very loud murmur that can be heard with the edge of the stethoscope in contact with the skin.
  • 6/6: A murmur audible with the stethoscope off the chest.

Systolic Murmur

A systolic murmur is an abnormal sound that is present in systole, between the first heart sound (S1) and the second heart sound (S2).
Note whether the murmur is present in early, middle or late systole, or is pansystolic.
  • Causes of Systolic Murmur

  • Aortic stenosis
  • Mitral regurgitation
  • Tricuspid regurgitation
  • Ventricular septal defect
  • Hypertrophic obstructive cardiomyopathy
  • Pulmonary stenosis
Soft systolic murmur - likely innocent murmur due to physiological bloodflow
  • Systolic Murmur
Early systolic murmur - ventricular septal defect, mitral regurgitation, tricuspid regurgitation
  • Systolic Murmur
Ejection (Mid)Systolic Murmur - aortic or pulmonary stenosis
  • Systolic Murmur
Late systolic murmur - mitral valve prolapse
  • Systolic Murmur
Pansystolic murmur - tricuspid or mitral regurgitation
  • Systolic Murmur

Diastolic Murmur

A diastolic murmur is an abnormal cardiac sound that is present during diastole, between S2 and S1. 
Note whether the murmur occurs in early, mid or late diastole.
  • Causes of Diastolic Murmur

  • Aortic regurgitation
  • Mitral stenosis
  • Pulmonary regurgitation
  • Tricuspid stenosis
Early diastolic - aortic or pulmonary regurgitation
  • Diastolic Murmur
Mid-diastolic - mitral stenosis
  • Diastolic Murmur
Late diastolic / presystolic - tricuspid stenosis
  • Diastolic Murmur

Continuous Murmur

  • Causes of Continuous Murmur

  • Patent ductus arteriosus
  • AV fistula
  • Ruptured sinus of Valsalva aneurysm
  • Aortopulmonary window
  • Continuous Murmur
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