Physical examination maneuver
Physical Exam
Cardiac Auscultation
How to Perform
With the patient supine or sitting in a quiet room, listen at the four standard areas — the second right interspace (aortic), the second left interspace (pulmonic), the lower left sternal border (tricuspid), and the cardiac apex (mitral) — using the diaphragm for high-pitched sounds and the bell for low-pitched sounds. At each site identify the first and second heart sounds, listen through systole and diastole for added sounds and murmurs, and note the timing, location, radiation, and intensity of any finding.
How to Interpret
Showing 12 of 55 findings
Acute Thoracic Aortic Dissection
Diastolic murmur of aortic regurgitation
Rule in
Not helpful
Rule out
Not helpful
Evidence:Strong
Aortic Regurgitation
Decrescendo diastolic murmur at left sternal border
Rule in
Helpful
Rule out
Somewhat helpful
Evidence:Limited
Aortic Stenosis
Diminished or absent A2 (soft second heart sound) on auscultation
Rule in
Very helpful
Rule out
Somewhat helpful
Evidence:Strong
Mid-to-late peaking systolic murmur (peak past mid-systole)
Rule in
Very helpful
Rule out
Somewhat helpful
Evidence:Limited
Systolic murmur
Rule in
Somewhat helpful
Rule out
Very helpful
Evidence:Limited
Systolic murmur radiating to the carotids
Rule in
Somewhat helpful
Rule out
Helpful
Evidence:Strong
Heart Failure
S3 gallop
Rule in
Very helpful
Rule out
—
Evidence:Strong
Hypertrophic Cardiomyopathy with Obstruction
Systolic murmur that decreases with isometric handgrip
Rule in
Somewhat helpful
Rule out
Very helpful
Evidence:Limited
Systolic murmur that increases with the Valsalva maneuver
Rule in
Very helpful
Rule out
Somewhat helpful
Evidence:Limited
Mitral Regurgitation
Systolic murmur
Rule in
Somewhat helpful
Rule out
—
Evidence:Limited
Pulmonary Hypertension
Loud P2
Rule in
—
Rule out
Minimally helpful
Evidence:Limited
Right-sided Valvular Lesion
Carvallo sign (systolic murmur intensity increases with inspiration)
Rule in
Helpful
Rule out
—
Evidence:Limited