Advanced Physical Diagnosis
  • Techniques
• 1st & 2nd Heart Sounds
• 2nd & 3rd Heart Sounds
• Clicks and Snaps
• Murmurs
• Rubs
  • Demonstrations
Associated Evaluations
  • Patient HX
  • Physical Exam
  • Laboratory & Imaging
Differential Dx
Evidence Base
• Accuracy in Diagnosis of Systolic Murmurs
• Accuracy in Diagnosis of Diastolic Murmurs
• Accuracy in Diagnosis of CHF
Teaching Tips
[Skill Modules >> Heart Sounds & Murmurs ]

Introduction: Examination for Heart Sounds & Murmurs

This module contains descriptions of techniques for the cardiac physical examination, focusing on heart sounds and murmurs. Other aspects of the cardiovascular examination are discussed in the modules on neck veins and pulmonary examination. Primary goals of this module are to enhance comfort in detecting and identifying heart sounds and to learn how to further evaluate murmurs.


The module describes the methods for detecting basic heart sounds and explains their significance and timing in the cardiac cycle. Importantly, examples of normal and abnormal sounds are presented for the listener to practice and develop auscultatory skills. Patience is required to train the ear to distinguish types of sounds with variable pitch and tone.

Evidence Base

The cardiac examination is rich with tradition and time-honored techniques. Increasingly, there is evidence for the predictive value of the dynamic cardiac exam.

Although recent studies show that trainees lack skills in identifying heart sounds, we believe accurate auscultation skills can be developed. Cardiac examination is an important step in distinguishing benign from worrisome sounds and murmurs. Accordingly, we present evidence - based recommendations for selective use of echocardiography as an adjunct directed by physical examination.

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