Timing and duration

Murmurs should be identified as being systolic or diastolic (or rarely, continuous).

The duration of systole and diastole can then be subdivided into the following
categories:
1.
2.
3.
4.
5.

Early, mid or late (proto, meso or telo) systolic or diastolic.

Pansystolic (from the beginning of S1 to the end of S2).
Holosystolic (from the end of S1 to the beginning of S2).
Holodiastolic (from the end of S2 to the beginning of S1).
Presystolic (between the A sound and S1).

Diagrammatic representation of these murmurs helps to clarify their timing and acts
as a useful reference for subsequent examinations (Figures 3.3-3.10).

Intensity
The intensity of a murmur is graded on a scale of 1-6 (or 1-5). Each grade should be
given in relation to the range used (e.g. grade 3/6). The grades are:
Grade 1: A quiet murmur that can be heard only after careful auscultation over a
localised area.
Grade 2: A quiet murmur that is heard immediately once the stethoscope is placed
over its localised PMI.
Grade 3: A moderately loud murmur.
Grade 4: A loud murmur heard over a widespread area, with no thrill palpable.
Grade 5: A loud murmur with an associated precordial thrill.
Grade 6: A murmur sufficiently loud that it can be heard with the stethoscope raised
just off the chest surface.
In general terms, loud murmurs are more likely to be significant than quiet murmurs.
However, some murmurs are not associated with a large volume of abnormal flow
but are very loud. This most often occurs when a structure is made to vibrate rapidly
in the jet of abnormal blood flow. Often these murmurs are musical. Theoretically, a
large abnormal communication may carry a substantial amount of low velocity blood
flow generating a murmur which may be of low intensity, or even absent. However,
this is rare and clinical signs are usually very severe before this stage is reached in
the horse.