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Graham-Steell murmur

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

The Graham Steell murmur is a heart murmur typically associated with pulmonary regurgitation. It is a high pitched early diastolic murmur heard best at the left sternal edge in the second intercostal space during inspiration [1].

Historical Perspective

It is named for Graham Steell.[2][3]

Pathophysiology

The murmur is heard due to a high velocity regurgitant flow across the pulmonary valve[4].

Differential Diagnosis of Underlying Causes

The Graham Steel murmur is most often a consequence of pulmonary hypertension. The Graham Steell murmur is often heard in patients with chronic cor pulmonale (pulmonary heart disease) as a result of chronic obstructive pulmonary disease.

Diagnosis

Physical Examination

The murmur is high-pitched and "blowing", and has a decrescendo configuration like that of aortic regurgitation. Differentiation is difficult by auscultation alone. The murmur may increase in intensity during inspiration and can be more localized. It is best heard over the left second and third intercostal space [5]

It begins with an accentuated P2 component of S2 and can be of variable duration. It may occupy all of diastole if there is a pandiastolic gradient between the pulmonary artery and the right ventricular diastolic pressure.

References

  1. "GRAHAM STEELL (1851-1942)--GRAHAM STEELL MURMUR". JAMA. 191: 671. 1965. PMID 14242430.
  2. McArthur JD, Sukumar IP, Munsi SC, Krishnaswami S, Cherian G (1974). "Reassessment of Graham Steell murmur using platinum electrode technique". Br Heart J. 36 (10): 1023–7. doi:10.1136/hrt.36.10.1023. PMC 1020054. PMID 4433433. Unknown parameter |month= ignored (help)
  3. Fraser AG, Weston CF (1991). "The Graham Steell murmur: eponymous serendipity?". J R Coll Physicians Lond. 25 (1): 66–70. PMID 2023159. Unknown parameter |month= ignored (help)
  4. Sakamoto T, Matsuhisa M, Hayashi T, Ichiyasu H (1975). "Echocardiogram and phonocardiogram related to the movement of the pulmonary valve". Jpn Heart J. 16 (2): 107–17. PMID 1117589.
  5. Perloff, JK. Auscultatory and phonocardiographic manifestations of pulmonary hypertension. Prog Cardiovasc Dis 1967; 9:303.



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