Clinical examination of heart murmurs
When listening to a patient's heart always consider the physical signs already elicited before auscultation commences.
Some hints concerning listening for murmurs:
- time the cardiac cycle by palpating one of the patient's carotid arteries
- the bell is good for hearing low-pitched sounds e.g. mitral stenosis. It should be applied very gently to the skin
- the diaphragm is good for listening to high-pitched murmurs e.g. aortic regurgitation
- left heart murmurs are louder in expiration
- right heart murmurs are louder in inspiration
- exercise makes a mitral stenotic murmur louder
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