Expansion
SCRIPT: Site, Character, Radiation, Intensity, Pitch, Timing
Expansion
SCRIPT:
- S - Site of maximal intensity
- C - Character: ejection, pansystolic, early diastolic, mid-diastolic
- R - Radiation: aortic stenosis to the carotids, mitral regurgitation to the axilla
- I - Intensity, graded 1 to 6
- P - Pitch: high pitched murmurs are best heard with the diaphragm, low pitched with the bell
- T - Timing: systolic or diastolic, established by palpating the carotid simultaneously
Levine grading
- Very faint, heard only with concentration
- Faint but immediately audible
- Moderate, no thrill
- Loud with a palpable thrill
- Very loud, thrill, audible with the stethoscope partly off the chest
- Audible with the stethoscope off the chest
Manoeuvres
- Inspiration accentuates right-sided murmurs; expiration accentuates left-sided (RILE)
- Sit forward in expiration for aortic regurgitation
- Left lateral position for mitral stenosis
- Valsalva and standing reduce most murmurs but increase those of hypertrophic obstructive cardiomyopathy and mitral valve prolapse