Heart Murmur

Midsystolic murmurs — also known as systolic ejection murmurs, or SEM — include the murmurs of aortic stenosis, pulmonic stenosis, hypertrophic obstructive cardiomyopathy and atrial septal defects.

Diastolic murmurs are graded on a scale of 1 to 4, while systolic murmurs are graded on a scale of 1 to 6.

In chronic aortic regurgitation, visible cardiac and arterial pulsations are common due to the large stroke volume, and the carotid pulse can commonly be seen.

Murmurs are described by their timing in the cardiac cycle, intensity, shape, pitch, location, radiation and response to dynamic maneuvers.

Still’s murmur (a.k.a. “innocent murmur” or “functional murmur”) refers to a benign flow murmur across the aortic valve from high cardiac output and/or increased contractility (inotropy).

A small ventricular septal defect is termed “maladie de Roger” or Rogers’s disease after the initial describer in 1879 Henri Louis Roger, a pediatric cardiologist known as an expert in cardiac auscultation.

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.

Carvallo’s sign occurs when the murmur of tricuspid valve regurgitation gets louder with deep inspiration. This, as well as the location of the murmur, helps to distinguish tricuspid regurgitation from mitral regurgitation.

Systolic murmurs are graded on a scale of 1-6 while diastolic murmurs are graded on a scale of 1-4 (see below).

Erb’s point is the auscultation location for heart sounds and heart murmurs located at the third intercostal space and the left lower sternal border.