Page 106 - Clinical Pearls in Cardiology

94 Clinical Pearls in Cardiology

15. How will you describe a cardiac murmur?
Cardiac murmurs are described according to their
timing in the cardiac cycle (i.e. systolic, diastolic, or
continuous), intensity (i.e. faint or loud), frequency (low
or high), duration (short or prolonged), configuration
(i.e. crescendo, decrescendo, crescendo-decrescendo or
plateau), location, radiation, quality (i.e. harsh, blowing
or rumbling), and the effect of respiration and/or other
physiologic maneuvers on their intensity. A crescendo
murmur is one which increases progressively in
intensity. A decrescendo murmur is one which decreases
progressively in intensity. A crescendo-decrescendo
murmur is a diamond-shaped murmur. The intensity of a
cardiac murmur is graded on a scale ranging from 1 to 6.

Grading of cardiac murmurs (Levine–Harvey)
Grade 1: Faintest murmur heard only with special effort
Grade 2: Faint murmur but heard immediately
Grade 3: Moderately loud murmur
Grade 4: Loud murmur associated with a thrill
Grade 5: Very loud murmur heard with part of stethoscope
touching the chest wall
Grade 6: Loudest murmur heard with stethoscope just removed
from the chest wall

16. What is the difference between conduction and
radiation of a murmur?
Conduction and radiation are two terms that are used to
describe the audibility of a cardiac murmur at a distant
location other than its site of origin. If a cardiac murmur
is heard with the same intensity at a distant location,
then the murmur is said to be conducted to that location