|
Valve |
Pathology |
Murmur |
Best Site for Auscultation |
Optimal Position |
SAMPLE SOUND |
|
Aortic Valve |
Aortic stenosis |
Systolic ejection murmur (crescendo-decrescendo) |
Right second intercostal space (aortic area) |
Sitting, leaning forward, after exhaling |
|
|
Aortic regurgitation |
Diastolic decrescendo murmur |
Left sternal border (3rd-4th intercostal spaces) |
Sitting, leaning forward, after exhaling |
|
|
|
Mitral Valve |
Mitral stenosis |
Diastolic rumbling murmur with opening snap |
Apex (left 5th intercostal space, midclavicular line) |
Left lateral decubitus |
|
|
Mitral regurgitation |
Holosystolic murmur |
Apex, radiating to axilla |
Left lateral decubitus |
|
|
|
Pulmonary Valve |
Pulmonary stenosis |
Systolic ejection murmur |
Left second intercostal space (pulmonic area) |
Sitting upright |
|
|
Pulmonary regurgitation |
Early diastolic murmur |
Left upper sternal border |
Sitting, leaning forward |
|
|
|
Tricuspid Valve |
Tricuspid stenosis |
Mid-diastolic murmur |
Left lower sternal border |
Deep inspiration |
|
|
Tricuspid regurgitation |
Holosystolic murmur |
Left lower sternal border |
Deep inspiration |
|
|
Congenital Anomaly |
Pathology |
Murmur |
Best Site for Auscultation |
Optimal Position |
SAMPLE SOUND |
|
Atrial Septal Defect (ASD) |
Left-to-right shunt across atrial septum |
Systolic ejection murmur + fixed split S2 |
Left upper sternal border (pulmonic area) |
Supine or sitting upright |
|
|
Ventricular Septal Defect (VSD) |
Left-to-right shunt across ventricular septum |
Harsh holosystolic murmur |
Left lower sternal border |
Supine |
|
|
Patent Ductus Arteriosus (PDA) |
Persistent ductus arteriosus |
Continuous "machinery-like" murmur |
Left infraclavicular area |
Supine or sitting upright |
|
|
Tetralogy of Fallot (TOF) |
Right ventricular outflow obstruction, VSD, overriding aorta, RVH |
Harsh systolic ejection murmur |
Left upper sternal border |
Squatting may reduce murmur intensity |
|
|
Coarctation of the Aorta |
Narrowing of aortic arch |
Systolic murmur, often with radiation to the back |
Left infraclavicular area and back |
Sitting, leaning forward |
|
|
Transposition of the Great Arteries (TGA) |
Parallel circulation with possible VSD or PDA |
No significant murmur unless associated defects present |
Variable, depends on associated defects |
Supine |
|
|
Tricuspid Atresia |
Hypoplastic right ventricle with ASD/VSD |
Holosystolic murmur (if VSD present) |
Left lower sternal border |
Supine |
|
|
Total Anomalous Pulmonary Venous Return (TAPVR) |
Pulmonary veins drain into right atrium |
Systolic ejection murmur |
Left upper sternal border |
Supine |
|
|
Ebstein's Anomaly |
Apical displacement of tricuspid valve |
Holosystolic murmur of tricuspid regurgitation |
Left lower sternal border |
Supine, intensified with deep inspiration |
|
