A Graham Steell murmur is a

heart murmur Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. Turbulent blood flow is not smooth. The sound di ...

typically associated with

pulmonary regurgitation Pulmonary (or pulmonic) insufficiency (or incompetence, or regurgitation) is a condition in which the pulmonary valve is incompetent and allows backflow from the pulmonary artery to the right ventricle of the heart during diastole. While a small ...

. It is a high pitched

early diastolic Early may refer to: History * The beginning or oldest part of a defined historical period, as opposed to middle or late periods, e.g.: ** Early Christianity ** Early modern Europe Places in the United States * Early, Iowa * Early, Texas * E ...

murmur heard best at the left sternal edge in the second

intercostal space The intercostal space (ICS) is the anatomic space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it. Structures in intercostal space * several kind ...

with the patient in full inspiration, originally described in 1888. The murmur is heard due to a high

velocity Velocity is the directional speed of an object in motion as an indication of its rate of change in position as observed from a particular frame of reference and as measured by a particular standard of time (e.g. northbound). Velocity i ...

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 semilunar v ...

; this is usually a consequence of pulmonary hypertension secondary to

mitral valve stenosis Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...

. The Graham Steell murmur is often heard in patients with chronic

cor pulmonale Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Chroni ...

(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 long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

. 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 Graham Steell (27 July 1851 – 10 January 1942) was a Scottish physician and cardiologist remembered for describing the Graham Steell murmur. Biography Graham Steell was born in 1851, the youngest son of Sir John Steell. He was educated ...

References

Heart murmurs {{med-sign-stub