A heart murmur is a series of audible vibrations detected with a stethoscope that can vary in intensity, frequency, duration, and location on the heart. Murmurs are classified based on their timing (systolic or diastolic), duration, pitch (low or high), character (rough, blowing, etc.), and grading on a scale of intensity. The transmission and loudness of a murmur can change with posture, breathing, and maneuvers like Valsalva or hand grips due to how it affects blood flow through the heart. Proper auscultation technique and positioning can help identify the cause and characteristics of a heart murmur.

1. DESCRIPTION OF MURMUR
A heart murmur is defined as a prolonged series of audible signals/vibrations of varying intensity ,
frequency , configuration and duration detectable with the aid of a stethoscope
SITE : Mitral / Tricuspid / Aortic – Neoaortic /Pulmonary
TIMING : Systolic , Diastolic , Continuous
DURATION : Early Systolic , Late Systolic , Pan Systolic ,
Early Diastolic , Mid Diastolic , Late Diastolic
CONFIGRATION : CRESCENDO (increasing) eg : ESM OF AS
DECRESCENDO(decreasing) eg : EDM OF AR
CRESCENDO- DECRESCENDO eg : SM OF AS and PS
PITCH : LOW PITCH – MS / TS ; HIGH PITCH – MR / AR
CHARACTER : Ruff Rumbling - MS/ Machinery - PDA/ Soft Blowing – AR/Loud Rough Harsh - AS
GRADING : Grade 1 – audible with difficulty
Grade 2 – faint but can be heard easily
Grade 3 – moderate intensity
Grade 4 – loud
Grade 5 – louder , but still in need of stethoscope
Grade 6 – audible without stethoscope
RADIATION : Conduction of Murmur occurs when direct anatomical continuity is present.
Eg :  Systolic Murmur of AS is conducted to the carotids
 PSM of MR is radiated to left axilla or base
Loud Murmurs transmit widely / Soft Murmurs are confined to area of origin
POSITION OF POSTURE : Supine / Left lateral / Sitting / Leaningforward
BELL OF STETH – MDM OF MS
STETHOSCOPE :
DIAPHRAGM - OTHER MURMURS
INSPIRATION / EXPIRATION : All Right sided Murmurs increases with inspiration except pulmonic ejection click
All Left sided Murmurs increase withexpiration except HOCM/MVP
DYNAMIC MANOEUVRE : SUPINE FROM STANDING OR SITTING/SQUATTING/ISOMETRIC HAND GRIP
VALSALVA : SM OF HOCM
SM OF AS , PS , MR , TR
DM OF AR , PR , MS , TS
POSTURAL CHANGE : SM OF PS , AS , MR , TR , VSD
SQUATTING : SM OF PS , AS , MR , VSD / SM OF HOCM
HAND GRIP : SM OF MR , VSD ; DM OF MS , AR
SM OF AS Dr.AashishChopra
( Diamond shaped)
References:Braunwald /Harrisons/ Raghawa rao clinical cardiology / Golwala physical diagnosis