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Secretary of State for Foreign and Commonwealth Affairs
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"Foreign Secretary" redirects here. For other uses, see Foreign secretary.
Secretary of State for Foreign and Commonwealth Affairs
Royal Arms used by Her Majesty's Government
Incumbent
Boris Johnson
since 13 July 2016 (2016-07-13)
Foreign and Commonwealth Office
Style
The Right Honourable
(within the UK and the Commonwealth)
His Excellency
(in international correspondence)[1]
Foreign Secretary (informal)
Member of
Cabinet
Privy Council
National Security Council
Reports to
Prime Minister of the United Kingdom
Residence
No 1 Carlton Gardens
Chevening
Seat
Westminster
Appointer
Monarch of the United Kingdom
Term length
At Her Majesty's pleasure
Inaugural holder
Charles James Fox
Formation
27 March 1782
Deputy
Sir Alan Duncan
as Minister of State for Europe
Website
Official website
United Kingdom
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Her Majesty's Principal Secretary of State for Foreign and Commonwealth Affairs, normally referred to as the Foreign Secretary, is a senior official within the Government of the United Kingdom and head of the Foreign and Commonwealth Office. The Foreign Secretary is a member of the Cabinet, and the post is considered one of the Great Offices of State. It is considered a position similar to that of Foreign Minister in other countries.
The Foreign Secretary's remit includes: relations with foreign countries, matters pertaining to the Commonwealth of Nations and the Overseas Territories in addition to the promotion of British interests abroad.[2] The Foreign Secretary also has ministerial oversight for the Secret Intelligence Service (MI6) and the Government Communications Headquarters (GCHQ).[3] The Foreign Secretary works out of the Foreign Office in Whitehall, and the post's official residences are 1 Carlton Gardens in London and Chevening in Kent. Margaret Beckett, appointed in 2006 by Tony Blair, is the only woman to have held the post.
The current Foreign Secretary is Boris Johnson, the former Mayor of London, who was appointed by Prime Minister Theresa May in July 2016.
Contents
[hide]
1 History
2 List of Foreign Secretaries
2.1 Secretaries of State for Foreign Affairs (1782–1968)
2.2 Secretaries of State for Foreign and Commonwealth Affairs (1968–present)
3 See also
4 References
5 External links
History[edit]
[show]History of United Kingdom government departments with responsibility for foreign affairs
Northern Department
1660–1782
Secretaries
Undersecretaries Foreign Office
1782–1968
Secretaries
Ministers
Undersecretaries Foreign and Commonwealth Office
1968–present
Secretaries
Ministers
Undersecretaries
Southern Department
1660–1768
Secretaries
Undersecretaries Colonial Office
1768–1782
Secretaries
Undersecretaries Home Office
1782–1794
Secretaries
Undersecretaries War Office
1794–1801
Secretaries
Undersecretaries War and Colonial Office
1801–1854
Secretaries
Undersecretaries Colonial Office
1854–1925
Secretaries
Undersecretaries Colonial Office
1925–1966
Secretaries
Ministers
Undersecretaries Commonwealth Office
1966–1968
Secretaries
Ministers
Undersecretaries
Southern Department
1768–1782
Secretaries
Undersecretaries Dominions Office
1925–1947
Secretaries
Undersecretaries Commonwealth Relations Office
1947–1966
Secretaries
Ministers
Undersecretaries
. India Office
1858–1937
Secretaries
Undersecretaries India Office
and
Burma Office
1937–1947
Secretaries
Undersecretaries
The position of Secretary of State for Foreign Affairs was created in the British governmental reorganisation of 1782, in which the Northern and Southern Departments became the Home and Foreign Offices, respectively. Eventually, the position of Secretary of State for Foreign and Commonwealth Affairs came into existence in 1968 with the merger of the functions of Secretary of State for Foreign Affairs and Secretary of State for Commonwealth Affairs into a single Department of State. The India Office was a constituent predecessor department of the Foreign Office, as were the Colonial Office and the Dominions Office.
List of Foreign Secretaries[edit]
Secretaries of State for Foreign Affairs (1782–1968)[edit]
Secretary of State for Foreign Affairs[4]
Portrait
Name[5]
(Birth–Death)
Term of office
Party
Ministry
Monarch
(Reign)
Ref.
The Right Honourable
Charles James Fox
MP for Westminster
(1749–1806) 27 March
1782 5 July
1782 Whig Rockingham II
George III

(1760–1820)
[1782 1]
[4]
The Right Honourable
Thomas Robinson
2nd Baron Grantham
PC
(1738–1786) 13 July
1782 2 April
1783 Whig Shelburne
(Whig–Tory) [4]
The Right Honourable
Charles James Fox
MP for Westminster
(1749–1806) 2 April
1783 19 December
1783 Whig Fox–North [4]
The Right Honourable
George Nugent-Temple-Grenville
3rd Earl Temple
PC
(1753–1813) 19 December
1783 23 December
1783 Tory Pitt I [4]
His Grace
Francis Osborne
5th Duke of Leeds
KGPC
(1751–1799) 23 December
1783 May
1791 Tory [4]
The Right Honourable
William Grenville
1st Baron Grenville
PCPC (Ire)
(1759–1834) 8 June
1791 20 February
1801 Tory [4]

The Right Honourable
Robert Jenkinson
2nd Baron Hawkesbury
PCFRS
MP for Rye[1782 2]
(1770–1828) 20 February
1801 14 May
1804 Tory [4]
Addington
The Right Honourable
Dudley Ryder
2nd Baron Harrowby
PCFSA
(1762–1847) 14 May
1804 11 January
1805 Tory Pitt II [4]
The Right Honourable
Henry Phipps
3rd Baron Mulgrave
PC
(1755–1831) 11 January
1805 7 February
1806 Tory [4]
The Right Honourable
Charles James Fox
MP for Westminster
(1749–1806) 7 February
1806 13 September
1806† Whig All the Talents
(Whig–Tory) [4]
The Right Honourable
Charles Grey
1st Viscount Howick
PC
MP for Northumberland
(1764–1845) 24 September
1806 25 March
1807 Whig [4]
The Right Honourable
George Canning
MP for Newtown (Isle of Wight) – Hastings[1782 3]
(1770–1827) 25 March
1807 11 October
1809 Tory Portland II [4]
The Right Honourable
Henry Bathurst
3rd Earl Bathurst
PC
(1762–1834) 11 October
1809 6 December
1809 Tory Perceval [4]
The Most Honourable
Richard Wellesley
1st Marquess Wellesley
KGPCPC (Ire)
(1760–1842) 6 December
1809 4 March
1812 Independent [4]
The Most Honourable
Robert Stewart
2nd Marquess of Londonderry
KGGCHPCPC (Ire)
(1769–1822) 4 March
1812 12 August
1822† Tory Liverpool [4]
George IV

(1820–1830)
The Right Honourable
George Canning
FRS
MP for 3 constituencies respectively
(1770–1827) 16 September
1822 30 April
1827 Tory [4]
The Right Honourable
John Ward
1st Earl of Dudley
PCFRS
(1781–1833) 30 April
1827 2 June
1828 Tory Canning
(Canningite–Whig) [4]
Goderich

Wellington–Peel
The Right Honourable
George Hamilton-Gordon
4th Earl of Aberdeen
KTFRSPCFSA Scot
(1784–1860) 2 June
1828 22 November
1830 Tory [4]
William IV

(1830–1837)
The Right Honourable
Henry John Temple
3rd Viscount Palmerston
GCBPC
MP for 3 constituencies respectively
(1784–1865) 22 November
1830 14 November
1834 Whig Grey [4]
Melbourne I
Field MarshalHis Grace
Arthur Wellesley
1st Duke of Wellington
KGGCBGCHPC
(1769–1852) 14 November
1834 18 April
1835 Tory Wellington Caretaker [4]
Conservative Peel I
The Right Honourable
Henry John Temple
3rd Viscount Palmerston
GCBPC
MP for Tiverton
(1784–1865) 18 April
1835 2 September
1841 Whig Melbourne II [4]
Victoria

(1837–1901)
The Right Honourable
George Hamilton-Gordon
4th Earl of Aberdeen
KTFRSPCFSA Scot
(1784–1860) 2 September
1841 6 July
1846 Conservative Peel II [4]
The Right Honourable
Henry John Temple
3rd Viscount Palmerston
GCBPC
MP for Tiverton
(1784–1865) 6 July
1846 26 December
1851 Whig Russell I [4]
The Right Honourable
Granville Leveson-Gower
2nd Earl Granville
PC
(1815–1891) 26 December
1851 27 February
1852 Whig [4]
The Right Honourable
James Howard Harris
3rd Earl of Malmesbury
PC
(1807–1889) 27 February
1852 28 December
1852 Conservative Who? Who? [4]
The Right Honourable
Lord John Russell
FRS
MP for the City of London
(1792–1878) 28 December
1852 21 February
1853 Whig Aberdeen
(Peelite–Whig) [4]

The Right Honourable
George Villiers
4th Earl of Clarendon
KGGCBPC
(1800–1870) 21 February
1853 26 February
1858 Whig [4]
Palmerston I
The Right Honourable
James Howard Harris
3rd Earl of Malmesbury
GCBPC
(1807–1889) 26 February
1858 18 June
1859 Conservative Derby–Disraeli II [4]
The Right Honourable
John Russell
1st Earl Russell
KGPCFRS
(1792–1878) 18 June
1859 3 November
1865 Liberal Palmerston II [4]

Russell II
The Right Honourable
George Villiers
4th Earl of Clarendon
KGGCBPC
(1800–1870) 3 November
1865 6 July
1866 Liberal [4]
The Right Honourable
Edward Stanley
Lord Stanley
PCFRS
MP for King's Lynn
(1826–1893) 6 July
1866 9 December
1868 Conservative Derby–Disraeli III [4]
The Right Honourable
George Villiers
4th Earl of Clarendon
KGGCBPC
(1800–1870) 9 December
1868 6 July
1870 Liberal Gladstone I [4]
The Right Honourable
Granville Leveson-Gower
2nd Earl Granville
KGPCFRS
(1815–1891) 6 July
1870 21 February
1874 Liberal [4]
The Right Honourable
Edward Stanley
15th Earl of Derby
PCFRS
(1826–1893) 21 February
1874 2 April
1878 Conservative Disraeli II [4]
The Most Honourable
Robert Gascoyne-Cecil
3rd Marquess of Salisbury
KGPCFRSDL
(1830–1903) 2 April
1878 28 April
1880 Conservative [4]
The Right Honourable
Granville Leveson-Gower
2nd Earl Granville
KGPCFRS
(1815–1891) 28 April
1880 24 June
1885 Liberal Gladstone II [4]
The Most Honourable
Robert Gascoyne-Cecil
3rd Marquess of Salisbury
KGPCFRSDL
(1830–1903) 24 June
1885 6 February
1886 Conservative Salisbury I [4]
The Right Honourable
Archibald Primrose
5th Earl of Rosebery
PCFRS
(1847–1929) 6 February
1886 3 August
1886 Liberal Gladstone III [4]
The Right Honourable
Stafford Northcote
1st Earl of Iddesleigh
GCBPCFRS
(1818–1887) 3 August
1886 12 January
1887† Conservative Salisbury II [4]
The Most Honourable
Robert Gascoyne-Cecil
3rd Marquess of Salisbury
KGPCFRSDL
(1830–1903) 14 January
1887 11 August
1892 Conservative [4]
The Right Honourable
Archibald Primrose
5th Earl of Rosebery
KGPCFRS
(1847–1929) 18 August
1892 11 March
1894 Liberal Gladstone IV [4]
The Right Honourable
John Wodehouse
1st Earl of Kimberley
KGPCDL
(1826–1902) 11 March
1894 21 June
1895 Liberal Rosebery [4]
The Most Honourable
Robert Gascoyne-Cecil
3rd Marquess of Salisbury
KGPCFRSDL
(1830–1903) 29 June
1895 12 November
1900 Conservative Salisbury III
(Con.–Lib.U.) [4]

The Most Honourable
Henry Petty-Fitzmaurice
5th Marquess of Lansdowne
KGGCSIGCMGGCIEPC
(1845–1927) 12 November
1900 4 December
1905 Liberal Unionist [4]

Edward VII

(1901–1910)
Balfour
The Right Honourable
Sir Edward Grey
BtDL
MP for Berwick-upon-Tweed
(1862–1933) 10 December
1905 10 December
1916 Liberal Campbell-Bannerman [4]

Asquith I

George V

(1910–1936)
Asquith II
(Lib.–Con.–et al.)
The Right Honourable
Arthur Balfour
OMFRSDL
MP for the City of London
(1848–1930) 10 December
1916 23 October
1919 Conservative Lloyd George
(I & II) [4]

The Most Honourable
George Curzon
1st Marquess Curzon of Kedleston
KGGCSIGCIEPC
(1859–1925) 23 October
1919 22 January
1924 Conservative [4]
Law
Baldwin I
The Right Honourable
Ramsay MacDonald
MP for Aberavon
(1866–1937) 22 January
1924 3 November
1924 Labour MacDonald I [4]
The Right Honourable
Sir Austen Chamberlain
KG
MP for Birmingham West
(1863–1937) 6 November
1924 4 June
1929 Conservative Baldwin II [4]
The Right Honourable
Arthur Henderson
MP for Burnley
(1863–1935) 7 June
1929 24 August
1931 Labour MacDonald II [4]
The Most Honourable
Rufus Isaacs
1st Marquess of Reading
GCBGCSIGCIEGCVOPCKC
(1860–1935) 25 August
1931 5 November
1931 Liberal National I
(N.Lab.–Con.–et al.) [4]
The Right Honourable
Sir John Simon
GCSIOBE
MP for Spen Valley
(1873–1954) 5 November
1931 7 June
1935 Liberal National National II [4]
The Right Honourable
Sir Samuel Hoare
BtGCSIGBECMGJP
MP for Chelsea
(1880–1959) 7 June
1935 18 December
1935 Conservative National III
(Con.–N.Lab.–et al.) [4]

The Right Honourable
Anthony Eden
MC
MP for Warwick & Leamington
(1897–1977) 22 December
1935 20 February
1938 Conservative [4]
Edward VIII

(1936)

George VI

(1936–1952)

National IV

The Right Honourable
Edward Wood
3rd Viscount Halifax
PC
(1881–1959) 21 February
1938 22 December
1940 Conservative [4]
Chamberlain War
Churchill War
(All parties)
The Right Honourable
Anthony Eden
MC
MP for Warwick & Leamington
(1897–1977) 22 December
1940 26 July
1945 Conservative [4]
Churchill Caretaker
(Con.–Lib.N.)
The Right Honourable
Ernest Bevin
MP for Wandsworth Central – Woolwich East[1782 4]
(1881–1951) 27 July
1945 9 March
1951 Labour Attlee
(I & II) [4]
The Right Honourable
Herbert Morrison
MP for Lewisham South
(1888–1965) 9 March
1951 26 October
1951 Labour [4]
The Right Honourable
Sir Anthony Eden
KGMC
MP for Warwick & Leamington
(1897–1977) 28 October
1951 7 April
1955 Conservative Churchill III [4]
Elizabeth II

(1952–present)
The Right Honourable
Harold Macmillan
MP for Bromley
(1894–1986) 7 April
1955 20 December
1955 Conservative Eden [4]
The Right Honourable
Selwyn Lloyd
CBEQC
MP for Wirral
(1904–1978) 20 December
1955 27 July
1960 Conservative [4]
Macmillan
(I & II)
The Right Honourable
Alec Douglas-Home
14th Earl of Home
PC
(1903–1995) 27 July
1960 20 October
1963 Conservative [4]
The Right Honourable
Richard Austen Butler
CH
MP for Saffron Walden
(1902–1982) 20 October
1963 16 October
1964 Conservative Douglas-Home [4]
The Right Honourable
Patrick Gordon Walker
MP for Smethwick[1782 5]
(1907–1980) 16 October
1964 22 January
1965 Labour Wilson
(I & II) [4]
The Right Honourable
Michael Stewart
MP for Fulham
(1906–1990) 22 January
1965 11 August
1966 Labour [4]
The Right Honourable
George Brown
MP for Belper
(1914–1985) 11 August
1966 16 March
1968 Labour [4]
The Right Honourable
Michael Stewart
MP for Fulham
(1906–1990) 16 March
1968 17 October
1968 Labour [4]
^† Died in office.
Jump up ^ The Prince of Wales served as Prince Regent from 5 February 1811.
Jump up ^ Elevated to the Peerage of the United Kingdom in November 1803.
Jump up ^ Elected to a new constituency in the 1807 general election.
Jump up ^ Elected to a new constituency in the 1950 general election.
Jump up ^ Lost seat in the 1964 general election.
Secretaries of State for Foreign and Commonwealth Affairs (1968–present)[edit]
Post created through the merger of the Foreign Office and the Commonwealth Office.
Secretary of State for Foreign and Commonwealth Affairs
Portrait
Name[5]
(Birth–Death)
Term of office
Party
Ministry
Sovereign
(Reign)
Ref.
The Right Honourable
Michael Stewart
MP for Fulham
(1906–1990) 17 October
1968 19 June
1970 Labour Wilson
(I & II)
Elizabeth II

(1952–present)
[4]
The Right Honourable
Sir Alec Douglas-Home
KT
MP for Kinross and Western Perthshire
(1903–1995) 20 June
1970 4 March
1974 Conservative Heath [4]
The Right Honourable
James Callaghan
MP for Cardiff South East
(1912–2005) 5 March
1974 5 April
1976 Labour Wilson
(III & IV) [4]
The Right Honourable
Anthony Crosland
MP for Great Grimsby
(1918–1977) 8 April
1976 19 February
1977† Labour Callaghan [4]
The Right Honourable
David Owen
MP for Plymouth Devonport
(born 1938) 22 February
1977 4 May
1979 Labour [4]
The Right Honourable
Peter Carington
6th Baron Carrington
KCMGMCPCDL
(born 1919) 5 May
1979 5 April
1982 Conservative Thatcher I [4]
The Right Honourable
Francis Pym
MC
MP for Cambridgeshire
(1922–2008) 6 April
1982 11 June
1983 Conservative [4]
The Right Honourable
Sir Geoffrey Howe
QC
MP for East Surrey
(1926–2015) 11 June
1983 24 July
1989 Conservative Thatcher II [4]

Thatcher III
The Right Honourable
John Major
MP for Huntingdon
(born 1943) 24 July
1989 26 October
1989 Conservative [4]

The Right Honourable
Douglas Hurd
CBE
MP for Witney
(born 1930) 26 October
1989 5 July
1995 Conservative [4]
Major I

Major II
The Right Honourable
Malcolm Rifkind
QC
MP for Edinburgh Pentlands
(born 1946) 5 July
1995 2 May
1997 Conservative [4]
The Right Honourable
Robin Cook
MP for Livingston
(1946–2005) 2 May
1997 8 June
2001 Labour Blair
(I–III) [4]
The Right Honourable
Jack Straw
MP for Blackburn
(born 1946) 8 June
2001 5 May
2006 Labour [4]
The Right Honourable
Margaret Beckett
MP for Derby South
(born 1943) 5 May
2006 28 June
2007 Labour [4]
The Right Honourable
David Miliband
MP for South Shields
(born 1965) 28 June
2007 11 May
2010 Labour Brown [4]
The Right Honourable
William Hague
FRSL
MP for Richmond (Yorks)
(born 1961) 11 May
2010 14 July
2014 Conservative Cameron–Clegg
(Con.–L.D.) [4]

The Right Honourable
Philip Hammond
MP for Runnymede and Weybridge
(born 1955) 14 July
2014 13 July
2016 Conservative [4]
Cameron II
The Right Honourable
Boris Johnson
MP for Uxbridge and South Ruislip
(born 1964) 13 July
2016 Incumbent Conservative May I [4]
May II
See also[edit]
Parliamentary Under-Secretary of State for Foreign Affairs
Permanent Under-Secretary of State for Foreign Affairs
Secretary of State for Commonwealth Affairs
Secretary of State for Commonwealth Relations
Secretary of State for the Colonies
Secretary of State for Dominion Affairs
Foreign minister
Great Offices of State
References[edit]
Jump up ^ "Public List" (PDF). Protocol and Liaison Service. United Nations. 24 August 2016. Retrieved 10 September 2017.
Jump up ^ "Secretary of State for Foreign and Commonwealth Affairs". Government of the United Kingdom. Retrieved 4 September 2014.
Jump up ^ "Ministerial responsibility". GCHQ. 23 March 2016. Retrieved 25 May 2017. Day-to-day ministerial responsibility for GCHQ lies with the Foreign Secretary.
^ Jump up to: a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch "Past Foreign Secretaries". gov.uk. Government of the United Kingdom. Retrieved 8 September 2017.
^ Jump up to: a b Including honorifics and constituencies for elected MPs.
External links[edit]
Wikimedia Commons has media related to Foreign Secretaries of the United Kingdom.
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Central Bank of West African States
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Central Bank of West African States
Banque Centrale des États de l'Afrique de l'Ouest (BCEAO) (in French)
BCEAO headquarters in Dakar, Senegal
Headquarters
Dakar, Senegal
Established
1959
President
Governor Kone Tiemoko Meyliet (no)
Central bank of
West African Economic and Monetary Union
Currency
West African CFA franc
XOF (ISO 4217)
Website
www.bceao.int
BCEAO is the central bank of the states in green.
The Central Bank of West African States (French: Banque Centrale des États de l'Afrique de l'Ouest, BCEAO) is a central bank serving the eight west African countries which share the common West African CFA franc currency and comprise the West African Economic and Monetary Union (UEMOA):
Benin
Burkina Faso
Guinea-Bissau
Ivory Coast (Côte d'Ivoire)
Mali
Niger
Senegal
Togo
The Bank is active in developing financial inclusion policy and is a member of the Alliance for Financial Inclusion.[1]
Contents
1 History
2 See also
3 References
4 External links
History[edit]
Its predecessor, the Institut d’Emission de l’Afrique Occidentale Française et du Togo, was created in 1955 and was transformed into BCEAO in 1959.[2][3][4] The treaty establishing the West African Monetary Union (UMOA), signed on May 12, 1962, gave BCEAO the exclusive right to issue the currency as the common central bank for the then seven member countries:[3][5][6]
Côte d’Ivoire
Dahomey (modern day Benin)
Haute-Volta (modern day Burkina Faso)
Mali
Togo
Niger
Senegal
See also[edit]
Banque des Etats de l'Afrique Centrale (BEAC)
Banque d'Afrique Occidentale (BAO) 1901-1962
Central banks and currencies of Africa
CFA Franc
West African CFA franc
Economy of Benin
Economy of Burkina Faso
Economy of Guinea-Bissau
Economy of Ivory Coast
Economy of Mali
Economy of Niger
Economy of Senegal
Economy of Togo
Payment system
Real-time gross settlement
References[edit]
Jump up ^ "AFI members". AFI Global. 2011-10-10. Archived from the original on 2012-02-20. Retrieved 2012-02-23.
Jump up ^ Mensah, A. (July 1979). "The Process of Monetary Decolonization in Africa" (PDF). Utafiti: Journal of the Faculty of Arts and Social Science, University of Dar Es Salaam. 4 (1): 48–49. Retrieved July 21, 2012.
^ Jump up to: a b "Dates clés" (in French). Central Bank of West African States. Retrieved July 21, 2012.
Jump up ^ "West African States CFA Franc Banknotes: First series of CFA banknotes issued by BCEAO 1959". Retrieved July 21, 2012. [permanent dead link]
Jump up ^ "Traité de l'Union Monétaire Ouest-Africaine" (in French). IZF. Archived from the original on February 22, 2013. Retrieved July 22, 2012. (Article 15)
Jump up ^ "Cadre Institutionnel" (in French). BCEAO. Retrieved July 22, 2012.
External links[edit]
(in French) (in English) Official site: Banque Centrale des États de l'Afrique de l'Ouest
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Heart murmur
From Wikipedia, the free encyclopedia
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Cardiac murmurs and other cardiac sounds
Auscultogram from normal and abnormal heart sounds
Classification and external resources
Specialty
Cardiology
ICD-10
R01
ICD-9-CM
785.2-785.3
DiseasesDB
29151
MedlinePlus
003266
MeSH
D006337
[edit on Wikidata]
Heart murmurs are heart sounds produced when blood flows across one of the heart valves that are loud enough to be heard with a stethoscope.
There are two types of murmurs. A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart. Other types of murmurs are due to structural defects in the heart itself. Functional murmurs are benign (an "innocent murmur").[1]
Murmurs may also be the result of various problems, such as narrowing or leaking of valves, or the presence of abnormal passages through which blood flows in or near the heart. Such murmurs, known as pathologic murmurs, should be evaluated by an expert.
Heart murmurs are most frequently categorized by timing, into systolic heart murmurs and diastolic heart murmurs, differing in the part of the heartbeat on which they can be heard. However, continuous murmurs cannot be directly placed into either category.[2]
Contents
[hide]
1 Classification
2 Interventions that change murmur sounds
3 Anatomic sources
4 Types and disease associations
5 Cooing dove murmur
6 See also
7 References
8 External links
Classification[edit]
Murmurs can be classified by seven different characteristics: timing, shape, location, radiation, intensity, pitch and quality.[3]
Timing refers to whether the murmur is a systolic or diastolic murmur.
Shape refers to the intensity over time; murmurs can be crescendo, decrescendo or crescendo-decrescendo. Crescendo murmurs progressively increase in intensity. Decrescendo murmurs progressively decrease in intensity. With crescendo—decrescendo murmurs (diamond or kite-shaped murmurs), a progressive increase in intensity is followed by a progressive decrease in intensity.
Location refers to where the heart murmur is usually heard best. There are four places on the anterior chest wall to listen for heart murmurs; each of the locations roughly corresponds to a specific part of the heart and should be listened to (through the stethoscope) with the patient lying down, face up. The four locations are:
Aortic region - the 2nd right intercostal space.
Pulmonic region - the 2nd left intercostal spaces.
Tricuspid region - the 4th left intercostal space.
Mitral region - the 5th left mid-clavicular intercostal space.
Additional maneuvers can be performed for additional auscultation:
Left lateral decubitus.
With the patient sitting upright.
With the patient leaning forward and exhaling.
Radiation refers to where the sound of the murmur radiates. The rule of thumb is that the sound radiates in the direction of the blood flow.
Intensity refers to the loudness of the murmur, and is graded according to the Levine scale, from 1 to 6:[4][5]
The murmur is only audible on listening carefully for some time.
The murmur is faint but immediately audible on placing the stethoscope on the chest.
A loud murmur readily audible but with no palpable thrill.[6]
A loud murmur with a palpable thrill.
A loud murmur with a palpable thrill. The murmur is so loud that it is audible with only the rim of the stethoscope touching the chest.
A loud murmur with a palpable thrill. The murmur is audible with the stethoscope not touching the chest but lifted just off it.
Pitch may be low, medium or high and is determined by whether it can be auscultated best with the bell or diaphragm of a stethoscope.
Quality refers to unusual characteristics of a murmur, such as blowing, harsh, rumbling or musical.
A mnemonic to remember what characteristics to look for when listening to murmurs is SCRIPT: Site, Configuration (shape), Radiation, Intensity, Pitch and quality, and Timing in the cardiac cycle.
The use of two simple mnemonics may help differentiate systolic and diastolic murmurs; PASS and PAID. Pulmonary and aortic stenoses are systolic while pulmonary and aortic insufficiency (regurgitation) are diastolic. Mitral and tricuspid defects are opposite.[7]
Interventions that change murmur sounds[edit]
Inhalation leads to an increase in intrathoracic negative pressure, which increases the capacity of pulmonary circulation, thereby prolonging ejection time. This will affect the closure of the pulmonary valve. This finding, also called Carvallo's maneuver, has been found by studies to have a sensitivity of 100% and a specificity of 80% to 88% in detecting murmurs originating in the right heart.[8][9] specifically positive Carvallo's sign describes the increase in intensity of a tricuspid regurgitation murmur with inspiration.[10]
Abrupt standing
Squatting, by increasing afterload and increasing preload.
Handgrip maneuver, by increasing afterload
Valsalva maneuver. One study found the Valsalva maneuver to have a sensitivity of 65%, specificity of 96% in detecting hypertrophic obstructive cardiomyopathy (HOCM).[8] Both standing and Valsalva maneuver will decrease venous return and subsequently decrease left ventricular filling, resulting in an increase in the loudness of the murmur of hypertrophic cardiomyopathy, since outflow obstruction is increased by decreasing preload. Alternatively, squatting increases systemic vascular resistance, increasing afterload and helping to hold the obstruction in a more open configuration, decreasing the murmur. Maximum handgrip exercise also results in a decrease in the loudness of the murmur.[11]
Post ectopic potentiation
Inhaled amyl nitrite is a vasodilator that diminishes systolic murmurs in left-to-right shunts in ventricular septal defects, and reveals right-to left shunts in the setting of a pulmonic stenosis and a ventricular septal defect.[12]
Methoxamine
Positioning of the patient. That is, putting patients in the left lateral position will allow a murmur in the mitral valve area to be more pronounced.
Anatomic sources[edit]
Systolic
Main article: Systolic heart murmur
Aortic valve stenosis typically is a crescendo/decrescendo systolic murmur best heard at the right upper sternal border sometimes with radiation to the carotid arteries. In mild aortic stenosis, the crescendo-decrescendo is early peaking whereas in severe aortic stenosis, the crescendo is late-peaking, and the S2 heart sound may be obliterated.
Stenosis of Bicuspid aortic valve is similar to the aortic valve stenosis heart murmur, but a systolic ejection click may be heard after S1 in calcified bicuspid aortic valves. Symptoms tend to present between 40 and 70 years of age.
Mitral regurgitation typically is a holosystolic (pansystolic) murmur heard best at the apex, and may radiate to the axilla or precordium. A systolic click may be heard if there is associated mitral valve prolapse. Valsalva maneuver in mitral regurgitation associated with mitral valve prolapse will decrease left ventricular preload and move the murmur onset closer to S1, and isometric handgrip, which increases left ventricular afterload, will increase murmur intensity. In acute severe mitral regurgitation, a holosystolic (pansystolic) murmur may not be heard.
Pulmonary valve stenosis typically is a crescendo-decrescendo murmur heard best at the left upper sternal border, associated with a systolic ejection click that increases with inspiration (due to increased venous return to the right side of the heart) and sometimes radiates to the left clavicle.
Tricuspid valve regurgitation presents as a holosystolic (pansystolic) murmur at the left lower sternal border with radiation to the left upper sternal border. Prominent v and c waves may be seen in the JVP (jugular venous pressure). The murmur will increase with inspiration.
Hypertrophic obstructive cardiomyopathy (or hypertrophic subaortic stenosis) will be a systolic crescendo-decrescendo murmur best heard at the left lower sternal border. Valsalva maneuver will increase the intensity of the murmur, as will changing positions from squatting to standing.
Atrial septal defect will present with a systolic crescendo-decrescendo murmur best heard at the left upper sternal border due to increased volume going through the pulmonary valve, and is associated with a fixed, split S2 and a right ventricular heave.
Ventricular septal defect (VSD) will present as a holosystolic (pansystolic) murmur at the left lower sternal border, associated with a palpable thrill, and increases with isometric handgrip. A right to left shunt (Eisenmenger syndrome) may develop with uncorrected VSDs due to worsening pulmonary hypertension, which will increase the murmur intensity and be associated with cyanosis.
Flow murmur may be heard at the right upper sternal border in certain conditions, such as anemia, hyperthyroidism, fever, and pregnancy.
Diastolic
Main article: Diastolic heart murmur
Aortic valve regurgitation will present as a diastolic decrescendo murmur heard at the left lower sternal border or right lower sternal border (when associated with a dilated aorta). This may be associated with bounding carotid and peripheral pulses (Corrigan's pulse, Watson's water hammer pulse), and a widened pulse pressure.
Mitral stenosis typically presents as a diastolic low-pitched decrescendo murmur best heard at the cardiac apex in the left lateral decubitus position. It may be associated with an opening snap. Increasing severity will shorten the time between S2(A2) and the opening snap. (i.e. In severe MS the opening snap will occur earlier after A2)
Tricuspid valve stenosis presents as a diastolic decrescendo murmur at the left lower sternal border, and signs of right heart failure may be seen on exam.
Pulmonary valve regurgitation presents as a diastolic decrescendo murmur at the left lower sternal border. A palpable S2 in the second left intercostal space correlates with pulmonary hypertension due to mitral stenosis.
Continuous and Combined Systolic/Diastolic
Patent ductus arteriosus may present as a continuous murmur radiating to the back.
Severe coarctation of the aorta can present with a continuous murmur: a systolic component at the left infraclavicular region and the back due to the stenosis, and a diastolic component over the chest wall due to blood flow through collateral vessels.
Acute severe aortic regurgitation is associated with a three phase murmur, specifically a midsystolic murmur followed by S2, followed by a parasternal early diastolic and mid-diastolic murmur (Austin Flint murmur). Although the exact cause of an Austin Flint murmur is unknown, it is hypothesized that the mechanism of murmur is from the severe aortic regurgitation jet vibrating the anterior mitral valve leaflet, colliding with the mitral inflow during diastole, with increased mitral inflow velocity from the narrowed mitral valve orifice leading to the jet impinging on the myocardial wall.[13][14]
Another uncommon cause of a continuous murmur is a ruptured sinus of valsalva.[15] Usually the murmur is well heard in the aortic area and along the left sternal border.
Types and disease associations[edit]
Continuous machinery murmur, at the left upper sternal border
Classic for a patent ductus arteriosus, and in serious cases associated with poor feeding, failure to thrive and respiratory distress. Other examination findings may include widened pulse pressures and bounding pulses.
Systolic murmur loudest below the left scapula
Classic for a coarctation of the aorta which is often seen in Turner's Syndrome, (gonadal dysgenesis), an X-linked disorder with a part missing of the X-chromosome. Other findings of this murmur is radio-femoral delay, and different blood pressures in the upper and lower extremities.
Harsh holosystolic (pansystolic) murmur at the left lower sternal border
Classic for a ventricular septal defect. It is in these children that the delayed-onset cyanotic heart disease occurs known as Eisenmenger syndrome, which is a reversal of the left-to-right heart shunt as the right ventricle hypertrophies, causing a right-to-left shunt and resulting cyanosis.
Widely split fixed S2 and systolic ejection murmur at the left upper sternal border
Classically due to a patent foramen ovale or atrial septal defect, which is lack of closure of the foramen ovale. This produces a left-to-right shunt initially, thus does not produce cyanosis, but causes pulmonary hypertension. Longstanding uncorrected atrial septal defects can also result in Eisenmenger's syndrome with resultant cyanosis.
Cooing dove murmur[edit]
The cooing dove murmur is a cardiac murmur with a musical quality (high pitched - hence the name) and is associated with aortic valve regurgitation (or mitral regurgitation before rupture of chordae). It is a diastolic murmur which can be heard over the mid-precordium.[1]
See also[edit]
Benign paediatric heart murmur
George Alexander Gibson discoverer of the Gibson murmur.
Precordial examination
References[edit]
Jump up ^ "heart murmur" at Dorland's Medical Dictionary
Jump up ^ "continuous murmur" at Dorland's Medical Dictionary
Jump up ^ "Heart murmur: characteristics". LifeHugger. Retrieved 2009-09-23.
Jump up ^ Orient JM. "Chapter 17: The Heart". Sapira's Art & Science of Bedside Diagnosis (4th ed.). Philadelphia: Wolters Kluwers Health. p. 339. ISBN 978-1-60547-411-3.
Jump up ^ Freeman AR, Levine SA (1933). "Clinical significance of systolic murmurs: Study of 1000 consecutive "noncardiac" cases.". Ann Intern Med. 6: 1371 –1379. doi:10.7326/0003-4819-6-11-1371.
Jump up ^ "Medline Plus Medical Dictionary, definition of "cardiac thrill"".
Jump up ^ https://www.youtube.com/watch?v=4euNGIguluk Mnemonic tutorial video for cardiac murmurs
^ Jump up to: a b Lembo N, Dell'Italia L, Crawford M, O'Rourke R (1988). "Bedside diagnosis of systolic murmurs". N Engl J Med. 318 (24): 1572–8. PMID 2897627. doi:10.1056/NEJM198806163182404.
Jump up ^ Maisel A, Atwood J, Goldberger A (1984). "Hepatojugular reflux: useful in the bedside diagnosis of tricuspid regurgitation". Ann Intern Med. 101 (6): 781–2. PMID 6497192. doi:10.7326/0003-4819-101-6-781.
Jump up ^ Harrison's Internal Medicine 17th, chapter 5, "Disorders of the cardiovascular system," question 32, self assessment and board review
Jump up ^ Harrison's Internal Medicine 17th, chapter 5, "Disorders of the cardiovascular system," question 86-87, self assessment and board review
Jump up ^ Cumming, Gordon R. (1963). "AMYL NITRITE INDUCED CHANGES IN CARDIAC SHUNTS". Br Heart J. 25 (4): 521–531. PMC 1018027  . PMID 14047161.
Jump up ^ John Oshinski; Robert Franch, MD; Murray Baron, MD; Roderic Pettigrew, MD (1998). "Images in Cardiovascular Medicine Austin Flint Murmur". Circulation. 98 (24): 2782–2783. PMID 9851968. doi:10.1161/01.cir.98.24.2782.
Jump up ^ "Blaufuss Multimedia - Heart Sounds and Cardiac Arrhythmias". Medical Multimedia Laboratories. Retrieved 2 August 2013.
Jump up ^ Topi, Bernard; John (September 2012). "An uncommon cause of a continuous murmur.". Experimental and clinical cardiology. 17 (3): 148–149. PMC 3628432  . PMID 23620707.
External links[edit]
Information on heart murmurs in children from Seattle Children's Heart Center
Heart Murmurs in Pediatric Patients
Lehrer, Steven. Understanding Pediatric Heart Sounds. Elsevier 2002.
Hanifin, Christopher. Heart Sounds: A Cardiac Auscultation Primer. CreateSpace, 2010
Texas Heart Institute Scroll down to listen to heart murmurs.
The Auscultation Assistant Provides recordings of heart murmurs.
Heart murmurs in children information for parents.
Patient and simulated holosystolic murmurs with audio, text, phonocardiograms and cardiac animations.
[show]
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Symptoms and signs relating to the cardiovascular system (R00–R03, 785)
Chest pain
Referred pain
Angina
Aerophagia
Auscultation
Heart sounds
Split S2
S3
S4
Gallop rhythm
Heart murmur
Systolic
Diastolic
Continuous
Pericardial friction rub
Heart click
Bruit
carotid
Pulse
Tachycardia
Bradycardia
Pulsus tardus et parvus
Pulsus paradoxus
doubled
Pulsus bisferiens
Dicrotic pulse
Pulsus bigeminus
Pulsus alternans
Pulse deficit
Vascular disease
Gangrene
Other
Palpitations
Apex beat
Cœur en sabot
Jugular venous pressure
Cannon A waves
Hyperaemia
Shock
Cardiogenic
Hypovolemic
Distributive
Septic
Neurogenic
[show]
v
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Eponymous medical signs for circulatory system
Heart disease
Heart murmur
Systolic heart murmur: Benign paediatric heart murmur (Still's murmur)
Diastolic heart murmur: Pulmonic regurgitation (Graham Steell murmur)
Aortic insufficiency (Austin Flint murmur) Carey Coombs murmur
Mitral regurgitation (Presystolic murmur)
Aortic insufficiency
Watson's water hammer pulse/Corrigan pulse
De Musset's sign
Duroziez's sign
Müller's sign
Quincke's sign
Austin Flint murmur
Mayne's sign
Other endocardium
endocarditis: Roth's spot
Janeway lesion/Osler's node
Bracht-Wachter bodies
Pericardium
Cardiac tamponade/Pericardial effusion: Beck's triad
Ewart's sign
Other
rheumatic fever: Anitschkow cell
Aschoff body
EKG (Osborn wave)
angina pectoris (Levine's sign)
Gallavardin phenomenon
Vascular disease
Arterial
aortic aneurysm (Cardarelli's sign, Oliver's sign)
pulmonary embolism (McConnell's sign)
radial artery sufficiency (Allen's test)
pseudohypertension (Osler's sign)
thrombus (Lines of Zahn)
Adson's sign
arteriovenous fistula (Nicoladoni sign)
Venous
Friedreich's sign
Caput medusae
Kussmaul's sign
DVT
Bancroft's sign
Homans sign
Lisker's sign
Louvel's sign
Lowenberg's sign
Peabody's sign
Pratt's sign
Rose's sign
Trendelenburg test
superior vena cava syndrome (Pemberton's sign)
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