Heart Murmur: Diagnosis & Tests Menu

How Are Heart Murmurs Diagnosed?

Since heart murmurs indicate abnormalities of flow, many of which are pathologic, the description of them is important in arriving at a diagnosis. They are described as to their:

  • Intensity (scale of Grade I–softest, to Grade V–which can be heard without a stethoscope)
  • Pitch (high or low frequency)
  • Quality (using descriptive adjectives such as scratchy, rumbling, vibratory, etc.)
  • Graduated loudness (the rise or fall of the volume)
  • crescendo, decrescendo, crescendo – decrescendo, and/or plateaued
  • Location (where on the chest it is best heard and does the sound radiate)
  • Timing and duration (systolic–early systolic, midsystolic, late systolic, or holosystolic (present the entire systole); diastolic–early diastolic, mid-diastolic, or late diastolic)

Systolic Murmurs (Between S1 and S2)

A murmur that occurs during systole is consistent with the following diagnoses:

  • Early systolic murmur: Mitral regurgitation, tricuspid regurgitation, or ventricular septal defect
  • Midsystolic murmur: Innocent flow murmurs, which may come and go based on hydration as a physiologic systolic “ejection” murmur; midsystolic murmurs, however, are also associated with aortic valve stenosis, prosthetic aortic valves, or pulmonic outflow obstruction
  • Late systolic murmur: Mitral valve prolapse, tricuspid valve prolapse, mitral regurgitation
  • Holosystolic murmur: Mitral regurgitation, tricuspid regurgitation, and ventricular septal defect

Diastolic Murmurs (Between S2 and the Next S1)

  • Early diastolic murmur: Aortic regurgitation, pulmonic regurgitation, and left descending coronary artery stenosis
  • Mid-diastolic murmur: Mitral stenosis, prosthetic mitral valve, tricuspid stenosis, atrial myxoma (obstruction); alternately, may represent increased flow across the atrioventricular valve
  • Late diastolic murmur: Mitral stenosis and tricuspid stenosis

It is said tongue-in-cheek that the most important diagnostic part of the stethoscope is the part between the ear pieces. As much a cliché as it is a truism, auscultation and deciphering of the timing and quality of murmurs, in experienced hands (ears), can raise suspicion of arteriovenous fistulas, aortic disease, and shunts through septal defects, in addition to all of the more frequently diagnosed abnormalities of cardiac structure, valvular properties, and dysfunction.


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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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