Intensity

The intensity of a murmur is a function of the cardiac output.

A grade 2/6 murmur in a child in heart failure may become a grade 4/6 after digitalization. Conversely, a grade 3/6 murmur in a child with fever and anemia may totally disappear when the anemia and the fever have abated.

The intensity of murmurs range from grade 1/6 to 6/6. The louder the murmur, the greater the likelihood of its being organic. A murmur is said to be at least Grade 4/6 if associated with a thrill (a palpatory vibration on the chest wall). A thrill is important because a murmur associated with a thrill is almost always organic.

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Objectives | History | Physical Exam | Cardiac Cycle | Murmurs |
Criteria for Referral | Compare Sounds | Case Studies | Samples of Murmurs