Character

Types

INTENSITY (Grade)	I/VI bearly audible II/VI faint but readuly heard III/VI moderately loud, without thrill IV/VI moderately loud, with thrill V/VI very loud with thrill VI/VI very loud with thrill, audible without stethoscope
PITCH	Low 25-125 cps Medium 150-350 cps High 350-600 cps
QUALITY	soft harsh rumble musical ejection, regurgitant, scratchy, etc.
LOCATION (cardiac cycle)	systolic protosystolic, mesosystolic, telesystolic, holosystolic diastolic protodiastolic, mesodiastolic, telediastolic, holodiastolic
LOCATION (chest wall)	valve area other
Configuration	crescendo decrescendo diamond-shaped (crescendo-decrescendo) plateau ejection, regurgitant, scratchy, etc.
Radiation	neck axilla back other
Modification	with maneuvers and interventions

Types of MURMURS

Character

Holosystolic MR, TR (almost always), VSD
Protosystolic (early systolic) severe MR, TR, smallVSD (or large ith PH).
Mesosystolic (midsystolic) AS (prototype), PS. Usually diamond-shaped. Functional (the majority and in the pulmonic area).
Telesystolic (late systolic) Late MR by prolapse, (high-pitched, after click).
Holodiastolic
Protodiastolic (early diastolic) AR, PR (hypertension). Grade I or II/VI, high pitched, decrescendo.
Mesodiastolic (middiastolic) MS or TS. Low-pitched, follows the opening snap. Austin-Flint murmur in chronic AR (soft and low-pitched, sometimes presystolic). Graham-Steell murmur in PR (high-pitched, decrescendo). Carey-Coombs murmur in Rheumatic fever (soft).
Presystolic (late diastolic) MS or TS. Crescendo.
Continuous (systolic-diastolic) Pulmonary embolism, Coarctation of the Aorta, AV fistula. mammary souflle = pregnancy (innocent murmur). Gibson murmur = PDA (+late systolic).