| Physical Finding | Associated cardiac condition(s) |
| Timing | |
| Early systolic | Ventricular septal defect, acute mitral regurgitation, acute tricuspid regurgitation |
| Holosystolic (pansystolic) | Mitral regurgitation, tricuspid regurgitation, ventricular septal defect |
| Midsystolic (ejection systolic) | Aortic stenosis, pulmonary stenosis, hypertrophic obstructive cardiomyopathy, atrial septal defect, aortic coarctation, pregnancy, mammary soufflé, innocent murmur |
| Late systolic | Myocardial infarction, ischemia, diffuse myocardial disease, mitral regurgitation from mitral valve prolapse |
| Early diastolic | Aortic regurgitation, pulmonary regurgitation (± Graham Steell murmur) |
| Middiastolic | Mitral stenosis, tricuspid stenosis, atrial myxoma (right or left), acute severe aortic regurgitation (Austin-Flint murmur), acute rheumatic fever (Carey Coombs murmur) |
| Presystolic (Late diastolic) | Tricuspid stenosis, mitral stenosis, atrial myxoma (right or left), acute severe aortic regurgitation (Austin-Flint murmur) |
| Continuous | Patent ductusarteriosus, cervical venous hum, mammary soufflé, congenital or acquired arteriovenous shunt (e.g. coronary arteriovenous fistula, ruptured aneurysm of aortic sinus of valsalva into a right heart chamber, anomalous left coronary artery, intercostal arteriovenous fistula), small atrial septal defect with a high left atrial pressure, proximal coronary artery stenosis, pulmonary artery branch stenosis, bronchial collateral circulation, aortic coarctation |
| Modulation (shape) | |
| Diamond (crescendo-decrescendo) | Aortic stenosis, pulmonary stenosis, hypertrophic obstructive cardiomyopathy |
| Decrescendo | Aortic regurgitation, pulmonary regurgitation |
| Plateau | Mitral regurgitation, tricuspid regurgitation |
| Location | |
| 5th intercostal space mid-clavicular line / apical | Mitral stenosis/regurgitation, hypertrophic obstructive cardiomyopathy |
| Right 5th interspace | Tricuspid stenosis/regurgitation |
| Right 2nd interspace / base | Aortic stenosis/regurgitation |
| Right 1st interspace or higher | Supravalvular aortic stenosis |
| Right supraclavicular fossa | Cervical venous hum |
| Left 2nd interspace / upper sternal border | Pulmonic stenosis/regurgitation, patent ductusarteriosus |
| Left 3rd-4th interspace | Tricuspid regurgitation, hypertrophic obstructive cardiomyopathy |
| Left & Right of sternum, 4th-6th interspace | Ventricular septal defect |
| Back/ interscapular | Patent ductusarteriosus, aortic coarctation |
| Intensity | |
| 1 | Faint, must tune in |
| 2 | Easily heard |
| 3 | Moderately loud |
| 4 | Palpable thrill and loud |
| 5 | Very loud |
| 6 | Heard with stethoscope off chest |
| Frequency (pitch) | |
| High | Mitral regurgitation, acquired pulmonary regurgitation, aortic regurgitation |
| Low | Mitral stenosis (rumble), tricuspid stenosis, congenital pulmonary regurgitation, acute severe aortic regurgitation |
| Radiation | |
| Axillary | Mitral regurgitation (anterior or laterally directed jet) |
| Back / Subscapular | Mitral regurgitation (posteriorly directed jet), patent ductusarteriosus, aortic coarctation |
| Neck (Carotids) | Aortic stenosis, hypertrophic obstructive cardiomyopathy, supravalvular aortic stenosis (louder in right neck) |
| Quality | |
| Blowing | Mitral regurgitation |
| Varying throughout cycle | Pericarditis (Pericardial friction rub) |
| Maneuver | Murmur that becomes louder |
| Squatting, raising legs i.e. increase venous return (left ventricular volume) | Aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, ventricular septal defect, patent ductusarteriosus |
| Valsalva, inhalation of amyl nitrate, sitting up, standing i.e. decrease left ventricular volume | Mitral valve prolapse (& lengthens murmur), hypertrophic obstructive cardiomyopathy |
| Handgrip, phenylephrine, or transient arterial occlusion by inflation of bilateral arm cuffs to 20mmHg above systolic blood pressure for 5 seconds (increases systemic arterial resistance) | Mitral regurgitation, aortic regurgitation, ventricular septal defect |
| Holosystolic louder in inspiration | Tricuspid regurgitation (Carvallo's sign), Pulmonary stenosis, pulmonary regurgitation |
| Following a premature beat or a long RR interval | Aortic stenosis, pulmonary stenosis |
| Extra signs | |
| Other physical findings to support your diagnosis | Blood pressure, jugular venous pulse, thrill, apex beat, peripheral pulse characteristics, changes in first or second heart sound, presence of third or fourth heart sound |
| Pleural effusion | Left heart failure |
| Inspiratory rales | Left heart failure |
| Pulsatile mass below umbilicus | Abdominal aortic aneurysm |
| Abdominal bruit (lateral) | Renovascular hypertension |