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. The murmur results from the rubbing of the pericardium against the pleura in the context of hyperdynamic circulation and tachycardia, and may mimic the sound of a pericardial rub.
The sign was described by J. Lerman M.D. and J. H. Means M.D. of Massachusetts General Hospital in 1932.
References
- Williams, Mark E (2007). "15. The Cardiovascular System". Geriatric physical diagnosis: a guide to observation and assessment (illustrated ed.). McFarland. p. 175. ISBN 978-0-7864-3009-3.
- Recognizing Thyroid Storm in the Neurologically Impaired Patient: Pathophysiology at Medscape
- Fadel BM, Ellahham S, Ringel MD, Lindsay J, Wartofsky L, Burman KD (June 2000). "Hyperthyroid heart disease" (PDF). Clin Cardiol. 23 (6): 402–8. doi:10.1002/clc.4960230605. PMC 6654928. PMID 10875028. Archived from the original (PDF) on 2011-07-26. Retrieved 2010-11-15.
- J. Lerman M.D.; J. H. Means M.D. (October 1932). "Cardiovascular symptomatology in exophthalmic goiter". Am Heart J. 8 (1): 55–65. doi:10.1016/S0002-8703(32)90027-1.
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