Normal Heart Sound - Normal Heart Sound showing S1 and S2. No audible murmurs.

Contributed by Thinklabs Medical.

Aortic Regurgitation - Murmur best heard with patient sitting forward, Stethoscope in bell mode positioned over the second intercostal space to the right of right of the sternal border, or over the 3rd - 4th intercostal space just to the left of the sternal border. Murmur is enhanced during expiration.

Note that the aortic component of the second heart sound is soft. The characteristic murmur is an early diastolic murmur. The intensity is loudest at the onset of diastole and becomes softer during diastole - the so-called "decrescendo" murmur.

Contributed by Dr. Darryl A Smith FCP (SA) Cardiology

Aortic Regurgitation with Ejection Systolic Mumur

The stethoscope is positioned towards the left sternoclavicular junction. Note in this recording the ejection systolic murmur early in systole. The aortic regurgitant murmur is less prominent in this position. Patients with aortic valvular disease may have concomitant aortic stenosis and aortic regurgitation, or may have isolated aortic regurgitation. This patient had isolated aortic regurgitation.

The incompetent valve allows blood to re-enter the left ventricle, which results in an increased volume of blood being ejected during the subsequent beat. The increased volume of blood ejected during systole creates an audible ejection systolic murmur.

Contributed by Dr. Darryl A Smith FCP (SA) Cardiology

Aortic Stenosis, Severe - Systolic Murmur. Harsh blowing sound, crescendo / decrescendo during systole, followed by S2. Recording Note: Diaphragm mode recording 0-14 sec. followed by Bell Mode recording 14-29 sec. with increase in S2 due to greater low frequency sensitivity in Bell mode.



Contributed by Division of Cardiology, Emory University School of Medicine.

Korotkoff Sounds - Blood pressure sounds with slowly deflating cuff. Notice that slower deflation provides for more beats and potentially increased accuracy for onset of systole or detection of diastolic end-point.



Contributed by Alice Mayfield, Mechanical & Biomedical Engineering, Carnegie-Mellon University

Coarctation of the Aorta - Usually occurs proximal to the origin of the left subclavian artery. The murmur is best heard with the stethoscope positioned Posteriorly in the left suprascapular region using the diaphragm mode. A thrill may be palpable over the left ribs posteriorly due to collateral arteries involving the intercostals arteries.

Contributed by Dr. Darryl A Smith FCP (SA) Cardiology

Hypertrophic Cardiomyopathy

The recording was made with the patient supine. The stethoscope is positioned in the 3rd - 4th intercostal space along the left parasternal border i.e just to the left of the sternum using the diaphragm mode. The stethoscope is over the left ventricular outflow tract, below the level of the aortic valve.

The obstruction is "dynamic", i.e the obstruction becomes progressively more severe as the ventricle contracts. The murmur therefore increases in intensity during systole as the obstruction increases.

The murmur may be confused with that of aortic stenosis. Note however that the aortic component of the second heart sound is easily audible, whereas in aortic stenosis the second heart sound is usually soft.
 

Contributed by Dr. Darryl A Smith FCP (SA) Cardiology

Infective Endocarditis Mitral Regurgitation

Minor Cardiomyopathy- S3 immediately following S2, producing a "gallop." Third heart sound has low frequency energy and is best heard in Bell mode.

Contributed by Division of Cardiology, Emory University School of Medicine

Mitral Regurgitation - Holosystolic murmur, recorded at the Apex. High frequency murmur is clearly visible on the phonocardiogram. S2 is somewhat diminished at the Apex.

Contributed by Division of Cardiology, Emory University School of Medicine.

Mitral Stenosis - The typical auscultatory features of mitral stenosis are a loud S1, early opening snap (OS) of the mitral valve soon after S2, a low-pitched mid-diastolic murmur (MDM) or "rumble" and pre-systolic accentuation (PSA). The murmur is best heard with the patient lying in the left lateral position, using the stethoscope in the Bell mode.

Contributed by Dr. Darryl A Smith FCP (SA) Cardiology.

Pericarditis - A pericardial friction rub is a rough scraping sound described as "leather rubbing against leather" that may be heard in systole and/or diastole. It is more pronounced if the patient is supine, and diminishes as the patient sits forward.

Contributed by Terry Bauch MD, FACC, FACP.

A Prosthetic Mitral Valve Systolic Murmur Mid-Diastolic Murmur

Prosthetic Mitral Valve Systolic Murmur Mid-Diastolic Murmur

Prosthetic Valve Aortic Valve Mitral Regurgitation

Prosthetic Valve Systolic Murmur

S4 Gallop - S4 occurs just prior to S1, clearly audible as 2 sounds - S4 quickly followed by S1. Fourth heart sound may be present in patients with hypertension or following an anterior myocardial infarct.

Contributed by Division of Cardiology, Emory University School of Medicine.

Ventricular Septal Defect - Congenital Muscular Ventricular Septal Defect in an adult. Low frequency systolic murmur. The murmur is characteristically loudest in the 4th intercostal space along the left parasternal border.

Contributed by Terry Bauch MD, FACC, FACP.