Heart Sounds and Murmurs

This new website is focused on providing auscultation training. Initially, we are providing a course for family practice and internal medicine, entitles Essential Heart Sounds. We are developing additional training modules as well as auscultation practice quizzes. So please check back with us again.

Heart Sounds Lessons

Our module, Essential Heart Sounds is an excellent way to learn commonly observed heart sounds. For many additional lessons, we recommend the website EasyAuscultation.com.

Essential Heart Sounds
This module, 'Essential Heart Sounds', is designed to provide auscultation instruction with practice exercises. The most important heart sounds found in family practice and internal medicine are covered. Each lesson consists of multiple pages: 1) text description with audio recording; 2)a visualization page with waveform; 3) animation of the heart valves and 4) a practice page. Use the tabs which appear below each lesson's title.

Lesson List

1	Normal First and Second Heart Sounds - No Splitting
2	Reduced Intensity First and Second Heart Sounds
3	Split Second Heart Sound
4	Third Heart Sound (S3) Gallop
5	Fourth Heart Sound (S4) Gallop
6	Third and Fourth Heart Sound Gallop
7	Summation Gallop at 120 beats per minute
8	Fixed Splitting of Second Heart Sound
9	Mid-Systolic Click
10	Systolic Murmur - Aortic Stenosis
11	Diastolic Murmur - Aortic Regurgitation
12	Mitral Valve Leaflet Prolapse
13	Pansystolic Murmur - Mitral Regurgitation
14	Diastolic Murmur - Mitral Stenosis

Heart Murmur Timing

When listening to heart murmur sounds, note the timing within a cardiac cycle. Systolic murmurs are heard between S1 (first heart sound) and S2 (second heart sound). Diastolic murmurs occur between S2 and S1. Murmurs can occur within systole or diastole and terms such as early systolic, mid-systolic or late systolic are used in our lessons.

Where to Auscultate

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

heart murmur sounds auscultation location areas

	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

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 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 immediatly decrease in intensity. These murmurs can also be called diamond shaped. Rectangular heart murmurs are of sound intensity.

crescendo-decresendo heart murmur phonocardiogram