Graham-Steell murmur


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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.

Historical Perspective
It is named for Graham Steell.

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

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.

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

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.