Means–Lerman scratch
Uncommon type of heart murmur
From Wikipedia, the free encyclopedia
The Means–Lerman scratch is an uncommon type of heart murmur which occurs in patients with hyperthyroidism. It is a mid-systolic scratching sound best heard over the upper part of the sternum or second left intercostal space at the end of expiration.[1] The murmur results from the rubbing of the pericardium against the pleura in the context of hyperdynamic circulation and tachycardia,[2] and may mimic the sound of a pericardial rub.[3]
The sign was described by J. Lerman M.D. and J. H. Means M.D. of Massachusetts General Hospital in 1932.[4]
