Murmur

Definition

A heart murmur is an abnormal sound heard with a stethoscope during the cardiac cycle, usually caused by turbulent blood flow across valves or through septal defects.

Grading (I to VI)

• I: Barely audible
• II: Quiet but clearly audible
• III: Moderately loud
• IV: Loud with palpable thrill
• V: Very loud, partial stethoscope contact
• VI: Audible without stethoscope

Common Causes

• Valve stenosis (narrowing): aortic, mitral, pulmonic, tricuspid
• Valve regurgitation (insufficiency)
• Septal defects (VSD, ASD)
• Patent ductus arteriosus
• Physiologic (athletic heart, pregnancy)

Nursing Interventions

Document location (aortic, pulmonic, Erb's point, tricuspid, mitral. 'APETM'), timing (systolic/diastolic), pitch, radiation, and grade. Correlate with clinical presentation. Evaluate with echocardiogram. Monitor for heart failure symptoms. Provide endocarditis prophylaxis when indicated before dental/invasive procedures.

NCLEX Relevance

Distinguish systolic (aortic stenosis, mitral regurgitation) vs diastolic (aortic regurgitation, mitral stenosis).