Graham Steell murmur: soft, blowing, decrescendo early diastolic murmur of pulmonary incompetence caused by pulmonary hypertension
It leads from an accentuated second sound that mimics the murmur of aortic insufficiency and is best heard at left sternal edge, second intercostal space in full inspiration.
1873 – Graham Steel working as intern for George Balfour (probably the originator of the murmur description)
1888 – First described to the Manchester Medical Society in 1888. Steell attributed the murmurs origin to pulmonary regurgitation caused by high pressure in the pulmonary artery in patients with mitral stenosis, and not disease of the pulmonary valve itself
I wish to plead for the admission among the recognised auscultatory signs of disease of a murmur due to pulmonary regurgitation, such regurgitation occurring independently of disease or deformity of the valves, and as the result of long-continued excess of blood pressure in the pulmonary artery
In cases of mitral obstruction there is occasionally heard over the pulmonary area (the sternal extremity of the third left costal cartilage), and below this region, for the distance of an inch or two along the left border of the sternum, and rarely over the lowest part of the bone itself, a soft blowing diastolic murmur immediately following, or, more exactly, running off from the accentuated second sound, while the usual indications of aortic regurgitation afforded by the pulse, etc., are absent. The maximum intensity of the murmur may be regarded as situated at the sternal end of the third and fourth intercostal spaces. When the second sound is reduplicated, the murmur proceeds from its latter part. That such a murmur as I have described does exist, there can, I think, be no doubt.Graham Steel 1888
- Graham Steell (1851-1942)
- Steell G. Murmur of high-pressure in pulmonary artery. The Medical Chronicle (Manchester). 1888;9:182 [Graham Steell murmur]
- Fraser AG, Weston CF. The Graham Steell murmur: eponymous serendipity? J R Coll Physicians Lond. 1991;25(1):66-70.
- Brest, AN, Udhoji V, Likoff W. A Re-Evaluation of the Graham-Steell Murmur. N Engl J Med 1960; 263:1229-1231
- Cohn KE, Hullgren HN. The Graham-Steell Murmur Re-Evaluated. N Engl J Med 1966; 274:486-489.
- Ma I, Tierney LM. Name that murmur–eponyms for the astute auscultician. N Engl J Med. 2010 Nov 25;363(22):2164-8
- Robbins A, Zhang G. Name that murmur. LITFL 2019
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