Means–Lerman scratch explained

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]

Notes and References

1. Book: Williams . Mark E . Geriatric physical diagnosis: a guide to observation and assessment . illustrated . 2007 . McFarland . 978-0-7864-3009-3 . 175 . 15. The Cardiovascular System.
2. http://www.medscape.com/viewarticle/554962_3 Recognizing Thyroid Storm in the Neurologically Impaired Patient: Pathophysiology
3. Fadel BM, Ellahham S, Ringel MD, Lindsay J, Wartofsky L, Burman KD . Hyperthyroid heart disease . Clin Cardiol . 23 . 6 . 402–8 . June 2000 . 10875028 . 10.1002/clc.4960230605 . 2010-11-15 . https://web.archive.org/web/20110726021318/http://www.uthsc.edu/cardiology/articles/Hyperthyroid%20Heart%20Dz%20review.pdf . 2011-07-26 . dead . 6654928 .
4. J. Lerman M.D. . J. H. Means M.D. . October 1932 . Cardiovascular symptomatology in exophthalmic goiter . Am Heart J . 8 . 1 . 55–65 . 10.1016/S0002-8703(32)90027-1.