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Auscultation of cardiac murmurs in adults

Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Cardiac auscultation is one of the most useful investigative tools that the physician can use at the bedside to detect alterations in cardiovascular anatomy and physiology. Most patients with significant valvular heart disease are first diagnosed based upon the finding of a murmur. Auscultation has a reported sensitivity of 70 percent and a specificity of 98 percent for detection of valvular heart disease [1]. However, the sensitivity and specificity vary substantially with the expertise of the examiner.

In clinical practice, echocardiography is the standard for establishing the cause of a murmur. As noted in major society guidelines, an echocardiogram is indicated for diagnosis and evaluation of patients with known or suspected valve disease [2,3]. Echocardiography is not needed in asymptomatic patients with a benign flow murmur but is appropriate in patients with cardiac symptoms and any cardiac murmur and asymptomatic patients with a diastolic murmur, a grade 3 or greater systolic murmur, or a systolic murmur in association with other abnormal exam findings, such as a systolic click or reduced carotid upstroke. The optimal management of valvular heart disease is based upon early diagnosis before the patient has become symptomatic.

This topic will review the auscultation of cardiac murmurs in adults, including the maneuvers (eg, respiration, Valsalva maneuver) that can be used to differentiate one murmur from another. These maneuvers, as well as auscultation of other heart sounds, are discussed in detail separately. (See "Physiologic and pharmacologic maneuvers in the differential diagnosis of heart murmurs and sounds" and "Auscultation of heart sounds".)

Cardiac murmurs in infants and children are discussed separately. (See "Approach to the infant or child with a cardiac murmur" and "Overview of common causes of cardiac murmurs in infants and children".)


The character of a murmur is described by a number of features, including intensity (grade), frequency, timing, shape, location, and radiation.


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Literature review current through: Nov 2016. | This topic last updated: Tue Dec 22 00:00:00 GMT 2015.
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