Heart Assessment

Murmur

A murmur is described as a soft blowing or gentle swooshing sound when auscultated.

Normally, as blood flows through the normal atria, ventricles, and competent valves, there are no sounds to auscultate. However, pathologies that alter turbulence, velocity, or viscosity of blood flow, may create murmurs/abnormal heart sounds; for example, valvular regurgitation or stenosis. When auscultating for a murmur, utilize the bell and the diaphragm and listen to all four valve sites.

Where do you auscultate the cardiac sounds and what are causes of abnormal heart sounds?

Cardiac Auscultatory Landmarks

You will best hear the sounds from each valve as labeled

Right Left

A-Aortic Valve

P-Pulmonic Valve

T-Tricuspid Valve

M-Mitral Valve

Murmurs from these valves also tend to be

loudest at these auscultatory landmarks.

Below are the heart sounds by Type, Auscultation site, Time in Cardiac Cycle and Diseases/Causes

S1 - "lub" sound High pitched

Apex

Beginning systole

Closing of mitral and tricuspid valves. Normal

Heard best at left sternal border

@ 5th inter-costal space

S2 - "dub" sound High pitched

Heard best with diaphragm

2nd intercostal

space

End of systole

Closing of pulmonic and aortic valves

Normal sound

S3 - Ventricular gallop Low pitched sound Heard best with bell

Apex

Early diastole just after S2

Early and rapid filling of ventricle (CHF): common in children, sometimes in adults older than 50 years and last trimester of pregnancy.

S4 - Ventricular gallop Low pitched sound Heard best with bell

Apex

Late in diastole just before S1

Atrium is filling against increased resistance of ventricle, as in CAD, CHF. Sometimes a normal finding in athletes and children.

#cardiaclandmarks