{"id":298,"date":"2010-12-02T13:33:07","date_gmt":"2010-12-02T13:33:07","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/murmurs\/"},"modified":"2023-01-11T23:10:32","modified_gmt":"2023-01-11T23:10:32","slug":"murmurs","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-cardiovascular-examination\/auscultation-the-cardiovascular-examination\/murmurs\/","title":{"rendered":"Murmurs"},"content":{"rendered":"<p>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:<\/p>\n<ul>\n<li>phase of the murmur: systolic or diastolic.<br \/>\n<em>for example: aortic valve stenosis systolic.<\/em><\/li>\n<li>duration of the murmur.<br \/>\n<em>for example: early, mid or holosystolic.<\/em><\/li>\n<li>position of the point of maximum sound (punctum maximum).<br \/>\n<em>for example: aortic stenosis: right parasternal 2nd intercostal space, mitral valve insufficiency: apex<\/em><\/li>\n<li>the presence of radiation.<br \/>\n<em>for example: towards the carotids in the case of aortic stenosis and to the axilla in the case of mitral valve insufficiency.<\/em><\/li>\n<li>intensity of the murmur, according to the Levine scale:<br \/>\n<em>grade 1:<\/em> very soft, requires good concentration to hear<br \/>\n<em>grade 2:<\/em> soft, but usually audible<br \/>\n<em>grade 3:<\/em> moderately loud but without palpable thrill (palpable vibration of the heart)<br \/>\n<em>grade 4:<\/em> loud with palpable thrill<br \/>\n<em>grade 5:<\/em> very loud with palpable thrill, audible even when stethoscope does not touch thorax wall<br \/>\n<em>grade 6:<\/em> loudest with palpable thrill, audible even without stethoscope<\/li>\n<li>change in intensity of the murmur. Increasing in intensity: crescendo. Decreasing in intensity: decrescendo.<\/li>\n<li>quality of the murmur, e.g. musical, blowing, harsh.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[119],"tags":[120],"class_list":["post-298","post","type-post","status-publish","format-standard","hentry","category-auscultation-the-cardiovascular-examination","tag-the-cardiovascular-examination"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Murmurs - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. Prepare for your OSCE.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.qpercom.com\/sim\/index.php\/the-cardiovascular-examination\/auscultation-the-cardiovascular-examination\/murmurs\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Murmurs - Qpercom | Skills in Medicine\" \/>\n<meta property=\"og:description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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