Heart murmurs (auscultation sites)

The preferred sites of auscultation of valvular heart murmurs are different from the surface markings of the valves on the anterior chest wall. This is because the transmission of murmurs is dependent on factors such as the proximity of the respective chamber to the thoracic cage and the direction of blood flow.

Hence, the following are locations at which there is the greatest probability of discerning valvular murmurs:

• aortic area:
  • right second intercostal space close to the sternum
  • the site where the ascending aorta is nearest to the thoracic cage
• pulmonary area:
  • left second intercostal space close to the sternum
  • the site where the infundibulum is closest to the thoracic cage
• mitral area:
  • at the position of the apex beat
  • left ventricle is closest to the thoracic cage at this point
• tricuspid area:
  • inferior left sternal margin
  • point closest to valve in which auscultation is possible