Where to Auscultate

The illustration provides a reference to auscultation positions which are used throughout our courses.

Aortic Valve Area Second right intercostal space (ICS), right sternal border Pulmonic Valve Area Second left intercostal space (ICS), left sternal border Erb's Point Third left ICS, left sternal border Tricuspid Valve Area Fourth left ICS, left sternal border Mitral Valve Area Fifth ICS, left mid-clavicular line

Please when listening to the sound, try to note:

Heart Murmur Length

A heart murmur's length (duration) to the how much of systole or diastole that the murmur occupies. Pansystolic or holosystolic murmurs last for the entire systole interval.

Murmur Pitch

Listening to the pitch of a heart murmur should be made, noting the pitch (frequency) as low, medium or high. The stethoscope's bell is useful for low pitched sounds. The stethoscope's diaphragm mode is used for medium or high pitched sounds.

Heart Murmur Shape

Murmurs can vary in sound volume during one heart beat. Murmurs that increase in volume intensity are called crescendo murmurs while those murmurs with decreasing sound levels are called decrescendo murmurs. Crescendo-decrescendo murmurs, also called diamond-shaped, have sound levels that increase then immediately decrease in intensity. These murmurs can also be called diamond shaped. Rectangular heart murmurs are of sound intensity.