Grading of cardiac murmurs

Q: There are how many grades to classify the intensity of heart murmur?

Answer: Six 

There are six grades to classify the intensity of a cardiac murmur. The actual term is "Levine Grading scale". Another objective of this question is to highlight that - technically - the perfect way to auscultate cardiac murmurs is to compare the intensity of a murmur with first [S1] and second [S2] heart sounds 

• Grade I: faintest murmur that can be heard only with difficulty; and murmur is usually softer than S1 and S2 sounds 
• Grade II: faint murmur, which has the same intensity as S1 and S2 sounds 
• Grade III: murmur auscultated relatively easy but not palpable as a thrill, and it is louder than the S1 and S2 sounds 
• Grade IV: murmur auscultated relatively easy and palpable as a thrill, and it is louder than the S1 and S2 sounds 
• Grade V: very loud with a thrill and can be heard with the slightest touch (only with the rim) of the stethoscope 
• Grade VI: loudest and can be heard without a stethoscope

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Reference: 

Silverman ME, Wooley CF. Samuel A. Levine and the history of grading systolic murmurs. Am J Cardiol. 2008 Oct 15;102(8):1107-10.