What is the levine grading scale?
In cardiology, the levine grading scale, or levine scale, is a six-point grading system that is used to define the volume or intensity of a heart murmur during examination with an acoustic stethoscope.
It is named after Samuel Albert Levine, an American cardiologist who introduced the system in 1933 while studying the significance of systolic heart murmurs. Physicians still use the system today to differentiate physiological and pathological murmurs.
How are murmurs distinguished?
Intensity is graded as follows using the levine scale during auscultation:
- The murmur can only be heard if one listens carefully for some time.
- The murmur is faint but can be heard straight away with a stethoscope.
- The murmur is moderately loud and can be heard immediately, but there is no palpable thrill or vibration that can be felt.
- The murmur is loud and accompanies a palpable thrill.
- The murmur accompanies a palpable thrill and is loud enough to be heard with just a slight touch of a stethoscope’s rim.
- The murmur accompanies a palpable thrill and is so loud that it can be heard before a stethoscope even makes contact with skin.
Murmur grades are normally recorded as fractions and roman numerals, such as III/VI.