More than 50% of common heart sounds and murmurs were misdiagnosed by medical students and residents.
Graphic documentation of auscultatory findings is no longer being obtained.
Evidence base for using auscultatory findings is limited and may not justify the time and money required to teach true proficiency.
Murmurs can be classified by intensity
Systolic murmurs can be classified by the physiology of their production rather than their timing
Various maneuvers affect the intensity of murmurs. Since each maneuver affects some murmurs more than others, there is diagnostic value in their application.
Innocent or functional murmurs generally need no additional workup, especially when the patient is asymptomatic.
The first heart sound coincides with mitral and tricuspid valve closure.
The components are heard best at the lower left sternal border.
The main diagnostic features of the first sound are intensity and splitting
The second heart sound is synchronous with aortic (A2) and pulmonic (P2) closure and with the dicrotic incisurae on aortic and pulmonic pressure tracings (hangout).
Abnormal splitting of the second heart sound has been described as widened, fixed, absent, reversed (paradoxic)
Most commonly helpful is probably paradoxic.
Most useful diagnosticaly is probably wide and fixed.
Abnormal systolic sounds can be early systolic or mid to late systolic.
Diastolic sounds can be grouped as early or mid to late diastolic sounds