Heart Murmurs

Definition

A heart murmur is sound produced by turbulent blood flow, particularly from the heart's valves. They can be found in infants or develop later in life. A heart murmur is often innocent and doesn't require treatment.

Heart Murmur Audio

Stethoscopes are used to listen to heart murmurs. A normal heartbeat sounds like "lub-DUB", which are the sounds of your heart valves closing. This "lub-DUB" sound changes, often with additional sounds being heard.

Heart Murmur Sounds

On this website, we provide lessons, reference guides and quizzes for auscultating heart murmurs. This includes gaining an understanding of cardiac rate and rhythm, conditions of the valves and possible anatomical abnormalities such as congenital defects. Links to our lessons, guides and quizzes are found in the 'Quick Links' box to the left. The remainder for this pages provides an overall listening guide for heart murmurs.

Timing and Cadence

Systolic murmurs occur between the first heart sound (S1) and the second heart sound (S2). Diastolic murmurs occur between S2 and S1. In addition, timing is used to describe when murmurs occur within systole or diastole. For example, early systolic, midsystolic or late systolic. See our courses on Systolic and Diastolic Murmurs for more information including audio recordings, waveforms and animations.

Heart Auscultation Points

Cardiac auscultation is performed systematically over five heart auscultation points on the anterior chest wall. Please refer to the torso illustation for each point. Use the stethoscope's diaphragm, switching to the bell to hear lower pitched sounds.

	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

Duration

Heart murmur duration refers to the portion of systole or diastole that the murmur occupies. Terms used include short and long. Murmurs lasting throughout systole are referred to as holosystolic or pansystolic.

Pitch

Evaluation of the murmur's pitch should be made by classifying the pitch (frequency) as low, medium or high. The stethoscope's bell can be helpful with low-pitched sounds while the diaphragm is used for medium or high-pitched sounds.

Shape

Tonal Quality

Listen for additional aspects of the murmur's sounds. Heart murmurs may have qualities that can be noted as musical, harsh, blowing, booming, sharp or dull.

Respiration and Patient Position

Respiration or patient position can influence murmur intensity as well as heart sound splitting. These factors will be described within the heart sound lessons. Generally speaking, murmurs increasing with expiration originate with left side (aortic or mitral) valves, while murmurs increasing in intensity with inspiration originate with tricuspid or pulmonary valves.

Within each lesson, the author provides an sketch of the patient's position during auscultation, such as supine, left lateral decubitus, squatting or sitting.