Levine grading scale:

1. The murmur is only audible on listening carefully for some time.
2. The murmur is faint but immediately audible on placing the stethoscope on the chest.
3. A loud murmur readily audible but with no palpable thrill.
4. A loud murmur with a palpable thrill.
5. A loud murmur with a palpable thrill. The murmur is so loud that it is audible with only the rim of the stethoscope touching the chest.
6. A loud murmur with a palpable thrill. The murmur is audible with the stethoscope not touching the chest but lifted just off it.

 

Systolic
     Holosystolic blowing murmur heard best at the apex radiating to the axilla
          Mitral regurgitation
     Short systolic murmur that decreases with squatting
          Mitral regurgitation
     Crescendo-decrescendo
          May radiate to the carotids
               Aortic stenosis
          Heard along L sternal border without carotid radiation 
               HOCM (especially in a young patient)
          Not otherwise specified is also consistent with
               Pulmonary valve stenosis
     Mid-systolic click over cardiac apex
          Mitral valve prolapse

Diastolic
     Early
          Aortic regurgitation (mild)
     Late-diastolic rumble at the apex
          Mitral stenosis
     Mid-distolic opening-snap
          Mitral stenosis
     Mid-diastolic rumble at the apex
          Intracardiac tumor obstructing the mitral valve
     Holodiastolic
          Aortic regurgitation (severe)

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.