A 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 with the patient in full
inspiration, originally described in 1888.
The murmur is heard due to a high
velocity
Velocity is a measurement of speed in a certain direction of motion. It is a fundamental concept in kinematics, the branch of classical mechanics that describes the motion of physical objects. Velocity is a vector (geometry), vector Physical q ...
flow back across the
pulmonary valve
The pulmonary valve (sometimes referred to as the pulmonic valve) is a valve of the heart that lies between the right ventricle and the pulmonary artery, and has three cusps. It is one of the four valves of the heart and one of the two semiluna ...
; this is usually a consequence of
pulmonary hypertension
Pulmonary hypertension (PH or PHTN) is a condition of increased blood pressure in the pulmonary artery, arteries of the lungs. Symptoms include dypsnea, shortness of breath, Syncope (medicine), fainting, tiredness, chest pain, pedal edema, swell ...
secondary to
mitral valve stenosis. The Graham Steell murmur is often heard in patients with chronic
cor pulmonale (pulmonary heart disease) as a result of
chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. GOLD defines COPD as a heterogeneous lung condition characterized by chronic respiratory s ...
.
In cases of mitral obstruction the murmur is occasionally heard over the pulmonary area and below this region, for the distance of an inch or two along the left border of the sternum.
It's also rarely over the lowest part of the bone itself, a soft blowing diastolic murmur immediately following P2.
It is named after
Graham Steell.
References
Heart murmurs
{{med-sign-stub