A murmur can develop as a consequence of constriction (stenosis) or leakage (insufficiency) of a heart valve or other open connections between the various heart chambers. A murmur as a consequence of a constriction is termed an ejection murmur and a murmur as a consequence of a leakage is known as a regurgitant murmur. Describing the murmur as accurately as possible allows any underlying pathology to be determined. The following aspects should be assessed:
- phase of the murmur: systolic or diastolic.
for example: aortic valve stenosis systolic. - duration of the murmur.
for example: early, mid or holosystolic. - position of the point of maximum sound (punctum maximum).
for example: aortic stenosis: right parasternal 2nd intercostal space, mitral valve insufficiency: apex - the presence of radiation.
for example: towards the carotids in the case of aortic stenosis and to the axilla in the case of mitral valve insufficiency. - intensity of the murmur, according to the Levine scale:
grade 1: very soft, requires good concentration to hear
grade 2: soft, but usually audible
grade 3: moderately loud but without palpable thrill (palpable vibration of the heart)
grade 4: loud with palpable thrill
grade 5: very loud with palpable thrill, audible even when stethoscope does not touch thorax wall
grade 6: loudest with palpable thrill, audible even without stethoscope - change in intensity of the murmur. Increasing in intensity: crescendo. Decreasing in intensity: decrescendo.
- quality of the murmur, e.g. musical, blowing, harsh.