Grading volume of a murmur

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Grading Volume of a Heart Murmurs:

The experienced examiner should be able to give the murmur a grade according to its loudness:   
Grade 1 – very faint murmur which is only audible during prolonged auscultation
Grade 2 – a faint murmur, immediately audible with a stethoscope
Grade 3 – loud murmur with NO thrill
Grade 4 – loud murmur WITH a thrill
Grade 5 – loud murmur WITH a thrill, heard with only half of the stethoscope touching the chest
Grade 6 – loud murmur WITH a thrill, heard WITHOUT the stethoscope touching the chest


Top tip: Never describe a murmur as grade 1 or 2 in OSCE examinations as it is commonly accepted
that only expert cardiologists can detect these murmurs! The grading system can be made easier by
remembering that grade 4 and above requires the presence of a thrill.

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