Cardiac murmur detected by the patient or a person nearby: an auditory finding indicating the need for surgical intervention.

• Vol 8 • May 2006 Musical Murmur Cardiac murmur is defined as an audit tory vibration that is more prolonged than heart sounds and is characterized by int tensity (loudness), frequency (pitch), cont figuration (shape), as well as the quality, duration and direction of radiation, and timing related to the cardiac cycle [1]. In daily practice these auscultatory findings can be detected either by stethoscope or documented by echocardiograpic Doppler flow signals. Based on S. Levine’s classification, a grade 1/6 murmur is so faint that it is hardly heard even with special efforts, whereas a grade 6/6 murmur is loud enough to be heard with the stethoscope just removed from the chest [2]. Cardiac murmurs detected by the human ear alone without the use of a stethoscope are very rare. The clinical conclusions that can be based on such auditory findings have not been well defined. We describe two patients who pret sented with sudden shortness of breath associated with “sounds” originating from the chest that were detected either by themselves or by their close family memt bers. In these cases urgent cardiac surgery was indicated.