Advanced Physical Diagnosis
  • Techniques
• 1st & 2nd Heart Sounds
• 2nd & 3rd Heart Sounds
• Clicks and Snaps
• Murmurs
• Rubs
  • Demonstrations
Associated Evaluations
  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• Accuracy in Diagnosis of Systolic Murmurs
• Accuracy in Diagnosis of Diastolic Murmurs
• Accuracy in Diagnosis of CHF
Teaching Tips
[Skill Modules >> Heart Sounds & Murmurs >> Techniques ]

Techniques: Heart Sounds & Murmurs

Murmurs (general) | Systolic | Diastolic


Cardiac murmurs can be divided into three categories based on where they occur in the cardiac cycle.
cardiac cycle graph
Systolic Murmurs Diastolic murmurs

Note: Short, quiet systolic murmurs are generally benign. Long systolic murmurs, diastolic murmurs and continuous murmurs are generally pathologic. (Two continuous murmurs that are benign are mammary soufflé and cervical venous hum.)

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Intensity of Murmur
Grade 1 just audible with a good stethoscope in a quiet room
Grade 2 quiet but readily audible with a stethoscope
Grade 3 easily heard with a stethoscope
Grade 4 a loud, obvious murmur with a palpable thrill
Grade 5 very loud, heard only over the pericardium but elsewhere in the body
Grade 6 heard with stethoscope off chest

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