11/11/2025
🎧 The Levine Scale is a classic system for grading the intensity of heart murmurs, ranging from 1/6 to 6/6.
Developed by cardiologist Samuel Levine in 1933, it remains the gold standard in international cardiology practice.
Knowing and using this scale:
- Simplifies communication with international colleagues
- Is essential for certification and standardized reporting
- Is referenced in all major global guidelines
It’s a simple yet powerful tool that helps standardize auscultation, support diagnostic reasoning, and improve communication among clinicians — a fundamental skill every practitioner should master.
📝How to Document Findings
✅ Correct: “Systolic murmur 4/6 at the aortic area, radiating to the carotids, with palpable thrill.”
❌ Incorrect: “Loud heart murmur.”
⚠️ Important Nuances
Intensity ≠ Severity
A soft diastolic murmur (2/6) may signal severe aortic regurgitation.
A loud systolic murmur (4/6) can be innocent in a child.
Always assess:
✅ Timing: systolic or diastolic
✅ Location & radiation
✅ Character: harsh, musical, blowing, decrescendo, etc.
✅ Associated symptoms: dyspnea, chest pain, syncope, edema
Takeaway:
The Levine Scale remains a timeless clinical language — a simple, universal code that bridges generations and borders in cardiology.
