Picking up a cardiac murmur is a desirable clinical skill. For this reason, it is a prevalent OSCE case in most clinical exams (of Cardiology, Internal Medicine, and Emergency Medicine).
Systolic murmurs are relatively easy to pick than diastolic murmurs. Having picked the murmur, when you narrate your findings, the examiners will ask about its different features. One of the features of a murmur that they may ask is – ‘what is the intensity of the murmur?’.
Systolic murmurs are louder than diastolic murmurs and have six intensity grades as compared to four in diastolic murmurs. These are given below:
Levine's Grading
Levine’s Grading classifies the intensity of systolic murmurs into six grades.
Grade 1 – Murmur is so faint, that it is heard only with special effort.
Grade 2 – Murmur is faint but readily detected,
Grade 3 – Murmur is prominent, easily audible but not associated with thrill.
Grade 4 – Murmur is loud and associated with thrill.
Grade 5 – Murmur is very loud.
Grade 6 – Murmur is loud enough, to be heard with the stethoscope, just removed from contact with the chest wall.