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Cardio Exam
 
 

Heart Auscultation

 
 
 
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Overview

When auscultating the heart, systematically listen to each of the cardiac regions for a heart sounds, murmurs or a rub. If added heart sounds or a murmur are noted, determine which area the extra sound is loudest in, and then perform manoeuvres to further isolate the added sound.
You may find it useful to start at the left sternal edge (tricuspid area) as an initial screening test, and then listen to the other areas.
Aortic Area - the second intercostal space at the right sternal border. The murmurs of aortic stenosis and regurgitation are loudest in this area, as is the aortic component of the second heart sound (A2).
Pulmonary Area - the second intercostal space at the left sternal border. The murmurs of pulmonary stenosis and regurgitation are loudest in this area, as is the pulmonary component of the second heart sound (P2)
Tricuspid Area - the fifth intercostal space at the left sternal border. The murmurs of tricuspid stenosis and regurgitation are loudest in this area, as is the first heart sound (S1).
Mitral Area - the fifth intercostal space in the midclavicular line. The murmurs of mitral stenosis and regurgitation are loudest in this area, as are the first heart sound (S1) and third heart sound (S3)
Left Axilla - the fifth intercostal space in the midaxillary line. The murmur of mitral regurgitation can be heard radiating to this area.
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