Surface anatomy (cardiac valves)

The surface markings on the anterior chest wall of the cardiac valves is typically retrosternal:

• pulmonary valve: junction of superior and middle thirds of the body of the sternum and slightly to the left side; near to left third costal cartilage
• aortic valve: just below and to the right of the pulmonary valve on the left side of the middle third of the sternum; level with the third intercostal space
• tricuspid valve: median plane in the inferior third of the sternal body; opposite the fourth costal cartilage
• mitral valve: overlapping tricuspid area but more superior and to the left of the sternal body

The surface markings of the valves are not the same locations as the preferred sites of auscultation of murmurs which emanate from them. This is because murmurs are dependent on the proximity of the heart chambers to the thoracic cage and the direction of blood flow.