Means-Lerman Scratch

The Means-Lerman scratch is a mid-systolic murmur heard in the setting of a hyperthyroid state at the left upper sternal border and end-expiration.

This is thought to occur from rubbing of the pericardium against the the pleura in the high output, hyperdynamic states of hyperthyroidism and may sound similar to a pericardial friction rub as seen in pericarditis.