I read "DM at RLSB" in a note from the medical personnel on a patient in the ICU. I know that DM typically stands for diabetes mellitus, and that RLSB typically stands for right lower sternal border, but I am quite puzzled by the phrase "DM at RLSB".

Context (which I am legally allowed to reproduce here):

T: 98.4, P: 88, BP: 101/50, R: 20, 97% 2L NC
GEN: elderly, chronically-ill appearing male, alert x 2
HEENT: anicteric, normal conjunctivea, pupils equal and
minimally reactive to light bilaterally, EOMI, OMM dry, OP
clear, neck supple, no JVD, masked facies, mild faical droop
Cardiac: irregulary irregular rhythm, II/VI SEM at apex, II/VI
PUlm: min crackles at bases b/l
ABD: NABS, soft, NT/ND, left sided hernia, no HSM
Ext: LLE shortened and externally rotated, left elbow with 5cm
skin tear and associated abrasion, actively dripping blood. 2+
radial pulses bilaterally, trace DP left, 1+ DP right, LLE
slightly cooler than RLE, sensation intact to light touch and
able to wiggle digits distally in upper and lower extremities
bilaterally. No significant hematoma noted at left hip. 1+ LE
edema 1/3 up calves bilaterally.


1 Answer 1


Diastolic Murmur [heard maximally at the] Right Lower Sternal Border

This is not the most typical description of any murmur, but it can be consistent with aortic regurgitation. Note that this patient had two murmurs described. In addition to DM/RLSB, he had a SEM = systolic ejection murmur (SEM). Both were described as II/IV intensity (read: two out of six), indicating a murmur that was faint but could be heard without difficulty.*

This is a good review on diastolic murmurs, usually considered to be an indicator of pathology. In contrast, systolic murmurs are at times consistent with normal physiology.

* Traditionally. Modern cardiologists tell me that those of us not trained in the good-ole’-days of cardiac auscultation tend to experience difficulty up to a higher threshold of intensity.

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