Heart Murmurs

  Grading of murmurs Grade Description Grade 1 Very faint Grade 2 Soft Grade 3 Heard all over the precordium Grade 4 Loud, with palpable thrill. Grade 5 Very loud, with thrill. May be heard when stethoscope is partly off the chest. Grade 6 Very loud, with thrill. May be heard with stethoscope entirely off… Read more »

Tanner Stages

The Tanner Stages (Tanner Scale) is a staging of physical development in children, adolescents and adults. The scale defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitalia, testicular volume, and the development of pubic and axillary hair. This scale was first identified by British pediatrician James Tanner. Here is the female Tanner stages: And here are the male… Read more »


Ventricular filling during atrial contraction Due to decreased ventricular compliance  (CAD, AS, MR, HCM, Diabetic Cardiomyopathy) ****No S4 during Atrial Fibrillation The S4 heart sound is associated with any process that increases the stiffness of the ventricle including: –>hypertrophy of the ventricle –>long-standing hypertension (causes ventricular hypertrophy) –>aortic stenosis (causes ventricular hypertrophy) –>overloading of the… Read more »


May be normal in people under 40 years of age and some trained athletes but should disappear before middle age. Caused by the oscillation of blood back and forth between the walls of the ventricles initiated by in-rushing blood from the atria. Due to: 1.Rapid ventricular filling ~  Ventricular decompensation (acutely) ~  Ventricular Septal Defect… Read more »


Closure of aortic and pulmonic valves just after systole. Here is a great review at Sanford’s School of Medicine Blog HERE Persistently split S2 (widened S2) is due to: Pulmonic Stenosis,  Pulmonary Embolism, or  RBBB (all cause delayed function of right ventricle.) A young girl with a split S2 and with RBBB on ECG is… Read more »