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Grading of the intensity of heart murmurs

Grading of the intensity of heart murmurs
Grade 1 Faintest sound that can be detected; often detected by cardiologists but not by general clinicians
Grade 2 Soft murmur that is readily detectable
Grade 3 Louder than grade 2 but not associated with a palpable thrill
Grade 4 Easily detected murmur associated with a palpable thrill*
Grade 5 Very loud murmur audible with the stethoscope placed lightly on the chest
Grade 6 Extremely loud murmur audible with the stethoscope off of the chest
* A grade 4 murmur requires the presence of a precordial thrill. A thrill located only in the suprasternal notch or neck and not on the precordium does not fulfill this criterion.
References:
  1. Marino BS, Goldblatt A. Heart sounds and murmurs. In: Lilly LS, ed. Pathophysiology of heart disease. Philadelphia: Lea & Febiger; 1992. p.18.
  2. Freeman AR, Levine SA. The clinical significance of the systolic murmur. A study of 1,000 consecutive "non-cardiac" cases. Ann Intern Med 6:1371, 1933.
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