Which condition is characterized by the presence of a thrill during a murmur?

A thrill is a palpable vibration often associated with turbulent blood flow within the heart or great vessels, and it is typically felt during auscultation of a murmur. This sensation indicates a more significant degree of turbulence and is generally present with higher-grade murmurs.

A Grade 4 murmur is characterized by a loud murmur that can be heard with a stethoscope, and it is often accompanied by a thrill. It suggests a considerable degree of turbulence and possible hemodynamic changes in the cardiovascular system. In clinical practice, the presence of a thrill usually points towards the severity of the underlying condition, which aligns with the characteristics of a Grade 4 murmur.

In contrast, lower-grade murmurs (such as Grade 3 or lower) typically do not produce enough turbulence to create a thrill; they can be heard but do not have the same implications for blood flow disturbances. Grade 5 murmurs are very loud and usually do include a thrill, while Grade 6 murmurs are even more intense and can be heard without the stethoscope being in contact with the chest, but the question clearly relates to the grade that is primarily known for the association with a thrill.

Therefore, identifying a Grade 4 murmur as the