Heart murmurs from valvular heart disease are best heard at specific locations on the chest where the sound radiates most clearly, corresponding to the affected valve’s anatomical position. Below is a concise list of the primary valvular murmurs (stenosis and regurgitation) and the optimal auscultation sites for each.

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Auscultation Sites for Valvular Murmurs

1. Aortic Stenosis (AS):
   • Best Heard: Right 2nd intercostal space (right upper sternal border)
   • Radiation: Often to carotids and neck
   • Description: Systolic, crescendo-decrescendo murmur
2. Aortic Regurgitation (AR):
   • Best Heard: Left 3rd–4th intercostal space (left sternal border) or right 2nd intercostal space
   • Radiation: May radiate to apex
   • Description: Diastolic, high-pitched, decrescendo murmur
3. Mitral Stenosis (MS):
   • Best Heard: Apex (5th intercostal space, midclavicular line), with patient in left lateral decubitus position
   • Radiation: Minimal, localized to apex
   • Description: Diastolic, low-pitched, rumbling murmur, often with opening snap
4. Mitral Regurgitation (MR):
   • Best Heard: Apex (5th intercostal space, midclavicular line)
   • Radiation: Often to left axilla or back
   • Description: Systolic, holosystolic (pansystolic), blowing murmur
5. Tricuspid Stenosis (TS):
   • Best Heard: Left lower sternal border (4th–5th intercostal space)
   • Radiation: Minimal, may radiate to right sternal border
   • Description: Diastolic, low-pitched, rumbling murmur
6. Tricuspid Regurgitation (TR):
   • Best Heard: Left lower sternal border (4th–5th intercostal space)
   • Radiation: May radiate to right chest or liver
   • Description: Systolic, holosystolic, high-pitched murmur, louder with inspiration
7. Pulmonic Stenosis (PS):
   • Best Heard: Left 2nd intercostal space (left upper sternal border)
   • Radiation: Minimal, may radiate to left neck
   • Description: Systolic, crescendo-decrescendo murmur
8. Pulmonic Regurgitation (PR):
   • Best Heard: Left 2nd–3rd intercostal space (left upper sternal border)
   • Radiation: Minimal
   • Description: Diastolic, decrescendo murmur, often high-pitched

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Key Auscultation Tips

• Standard Listening Points:
  • Aortic: Right 2nd intercostal space
  • Pulmonic: Left 2nd intercostal space
  • Tricuspid: Left lower sternal border
  • Mitral: Apex (5th intercostal space, midclavicular line)
• Patient Positioning:
  • Mitral murmurs (MS, MR): Enhanced in left lateral decubitus position.
  • Aortic regurgitation: May be louder with patient sitting and leaning forward.
  • Tricuspid murmurs: Often louder with inspiration (increased venous return).
• Use of Stethoscope:
  • Diaphragm: Best for high-pitched murmurs (e.g., AR, MR, TR).
  • Bell: Best for low-pitched murmurs (e.g., MS, TS).
• Associated Sounds:
  • Mitral stenosis: Often has an opening snap.
  • Aortic/pulmonic stenosis: May have an ejection click.

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