MVP = mitral valve prolapse
1-03a Normal first and second heart sounds at the apex
1-03b Normal heart sounds at the apex
1-07 Normal split S1
1-10 Normal splitting of S2 with respiratory effect
1-11 Splitting of the S2 with right bundle branch block
1-12 Paradoxical/reverse splitting of S2 with left bundle branch block
1-13 Fixed splitting of S2 in atrial septal defect
1-14a Mid-systolic click
1-14b Mid-systolic click added to normal heart sound
1-14c Mid-systolic click followed by late systolic murmur ending at S2
1-14d Normal heart sound with added mid-systolic click and late systolic murmur
1-14e Multiple microvalvular clicks in a patient with MVP
1-14f Mid-systolic click heard at the apex
1-14g Mid-systolic click heard at the fourth left interspace
1-14h Mid-systolic click heard at the second left interspace
1-14i Mid-systolic click heard at the second right interspace
1-14j Mid-systolic click heard at the apex in a patient in the left lateral position
1-15 Normal S3
1-17a S3 gallop rhythm in a patient with severe idiopathic dilated cardiomyopathy
1-17b S3 gallop sound
1-17c Normal S1 and S2 sounds with subsequent added S3 gallop sound
1-17d S3 gallop in a diabetic patient with severely dilated cardiomyopathy
1-18a S4 gallop rhythm
1-18b Normal S1 and S2 with S4 gallop rhythm added later in sample
1-18c S4 gallop repeated
1-18d S4 gallop at more rapid heart rate
1-22 Quadruple gallup rhythm
1-24 Pericardial knock recorded at the apex
1-25 Atrial myxoma tumor plop sound recorded at the apex with diastolic murmur
with presystolic accentuation ending at S1
1-26a Ejection sound of congenital bicuspid aortic stenosis with accompanying rough
mid-systolic murmur
1-26b S1 and S2 with added ejection sound of congenital bicuspid aortic stenosis and
2-02a Blowing systolic murmur
2-02b Rough or harsh systolic murmur
2-02c Musical systolic murmur
2-05a Mitral regurgitation demonstrating holosystolic blowing murmur at the apex
2-05b Rough or harsh systolic murmur of mitral regurgitation at the apex
2-05c Flailed mitral valve cusp, rough holosystolic murmur at the apex with
premature beats interrupting normal sinus rhythm
2-05d Flailed mitral valve cusp at the lower left sternal border
2-05e Flailed mitral valve cusp at the third left interspace
2-05f Flailed mitral valve cusp at the second right interspace
2-06a Holosystolic right mitral murmur at the apex in a patient with flailed mitral
valve with severe mitral regurgitation
2-06b Holosystolic right mitral murmur at the left infrascapular area in a patient with
flailed mitral valve with severe mitral regurgitation
2-07 Blowing holosystolic apical murmur with occasional premature beat and
supraventricular tachycardia with spontaneous remission to normal sinus rhythm
2-08a Rough holosystolic mitral murmur with a third heart sound
2-08b Rough holosystolic mitral murmur with a third heart sound dissected (normal,
rough, then with addition of S3 sound in diastole)
2-09a Holosystolic mitral murmur and mid-diastolic flow murmur at the apex
2-09b Holosystolic mitral murmur and mid-diastolic flow murmur at the apex
dissected (normal, holosystolic blowing mitral murmur, added S3 and subsequent
flow murmur)
2-10 Rough and loud holosystolic mitral murmur with absent S1
2-11a Mitral regurgitation plus mitral stenosis: apical holosystolic blowing murmur
with typical findings of mitral stenosis
2-11b Mitral regurgitation plus mitral stenosis: apical holosystolic blowing murmur
with typical findings of mitral stenosis dissected: S1 and S2; blowing holosystolic
murmur of mitral regurgitation; high pitched short opening snap and the middle
diastolic murmur of mitral stenosis with presystolic extenuation ending abruptly at the
sharp first heart sound
2-12 Tricuspid regurgitation at the lower left sternal border
2-13 Holosystolic rough murmur of a ventricular septal defect
2-14 Rough early systolic murmur at the fourth left interspace accompanied by a thrill
in that area
2-16a Late blowing systolic murmur of papillary muscle dysfunction
2-16b Mitral valve prolapse with a midsystolic click followed by a late blowing
systolic murmur
2-17a Acquired rheumatic aortic stenosis demonstrating characteristic loud rough
midsystolic murmur, diminished aortic second sound as a result of severe calcific
involvement with consequent partial immobilization of the valve leaflet at second
right interspace.
2-17b Loud midsystolic rough aortic stenotic murmur in the same patient as 2-17a,
demonstrating musical overtones at the apex.
2-18 Congenital bicuspid aortic stenosis with early high pitched ejection sound and
rough midsystolic murmur
2-20 Rough midsystolic murmur of aortic stenosis with S4 gallop from thickened
noncompliant left ventricle and vigorous atrial contraction
2-21 Loud aortic stenotic murmur after a premature beat at the base
2-24a Valsava maneuvre
2-24b Intensification of the murmur as patient stands up and then diminution of the
murmur as she squats
2-25 Innocent blowing midsystolic murmur in the second left interspace in a 10-yearold boy.
2-31a Mitral stenosis
2-31b Sharp S1 and normal S2 in mitral stenosis
2-31c Opening snap at the apex in mitral stenosis
2-31d Opening snap of the base in the third left interspace in the same patient as 2.31c
2-31e Classic presystolic murmur findings of mitral stenosis dissected.
2-31f Presystolic murmur ending abruptly at sharp S1
2-31g Presystolic murmur ending abruptly at sharp S1 with normal S2
2-31h Presystolic murmur with sharp S1 and normal S2 followed by the high-pitched
short opening snap.
2-31i Opening snap followed by the rough mid-diastolic murmur with presystolic
extenuation ending abruptly with the sharp S1
2-31j P2 accentuated as a result of pulmonary hypertension
2-31k Mitral stenosis with a patient with more rapid heart rate and normal sinus
rhythm after exercise.
2-31l Turning the patient to the left lateral position will increase the heart rate and
intensify the diastolic mumur.
2-33a Mitral stenosis and atrial fibrillation in a patient with a longer diastolic interval
and a greater S2/OS interval
2-33b The same patient as in 2.32a after a mitral valve replacement, with high pitched
short closure sound and opening sound following S2 of the prosthetic valve.
2-35 Tricuspid valve stenosis in a patient with carcinoid heart disease.
3-02 Loud early blowing aortic regurgitant murmur
3-04 Early blowing aortic diastolic murmur due to a paravalvular leak following
aortic valve replacement made at the fourth left interspace
3-06 Rheumatic aortic stenosis with aortic regurgitation with a rough mid-systolic
murmur, a diminished aortic S2, and an early blowing aortic diastolic murmur
3-09a Austin Flint murmur
3-09b Early blowing aortic diastolic murmur
3-09c Austin Flint low-pitch rough mid-diastolic murmur ending at S1
3-09d Austin Flint murmur heard in the apical area
3-10 Early diastolic murmur of a retroverted aortic valve cusp
3-11a Patent ductus arteriosus with continuous murmur
3-11b “Machinery shop” murmur
3-11c Patent ductus arteriosus before and after exercise
3-11d Mid-diastolic flow murmur in the apical area of patent ductus arteriosus patient
3-11e Patent ductus arteriosus and associated pulmonary hypertension with increased
P2
3-12a Venous hum
3-12b Venous hum after pressure on the right internal jugular vein
3-12c Return of venous hum after release of pressure on the right internal jugular vein
3-14a Loud rough holosystolic murmur in a patient with a relatively small ventricular
septal defect
3-14b S3 originating in the left ventricle as a result of a ventricular septal defect with
a large left to right shunt
3-14c Mid-diastolic flow murmur across the mitral valve at the apex due to a large
shunt from a ventricular septal defect
3-15a Widely split S2 in atrial septal defect associated with a mid-systolic murmur
3-15b Mid-systolic murmur at the tricuspid valve with loud P2
3-15c Initially, fixed widely split S2, followed mid-diastolic decrescendo murmur at
the tricuspid valve
3-16a Rough mid-systolic murmur preceded by an early ejection sound, a well-heard
S2 and a early blowing decrescendo diastolic murmur in congenital aortic stenosis and
aortic regurgitation
3-16b Initially S1 and S2, followed by the early ejection click, then the rough midsystolic murmur of congenital aortic stenosis and lastly the early blowing decrescendo
diastolic murmur of aortic regurgitation
3-17a Mild congenital pulmonary stenosis: intermittent presence of an ejection sound
after S1 during expiration, but not inspiration. Also present is a widely split S2.
3-17b Moderate congenital pulmonary stenosis: early ejection sound and mid-systolic
murmur occurring slightly later tending to envelope S2 while maintaining a widely
split S2
3-17c Severe congenital pulmonary stenosis: loud, rough mid-systolic murmur
enveloping aortic S2 and a delayed and barely heard P2 with very early ejection sound
3-17d Pulmonary stenosis with a right-sided S4 gallop rhythm
3-20 Loud rough holosystolic murmur, loud single S2, a loud S3 at the apex and an
ejection click in truncus arteriosus
3-21a Prominent ejection click in a patient with coarctation of the aorta
3-21b Early ejection sound, rough mid-systolic murmur and loud A2 in coarctation of
the aorta heard at the fourth left interspace
3-21c Early ejection sound, rough mid-systolic murmur and even louder A2 in
coarctation of the aorta heard at the third left interspace
3-21d Continuous murmur in coarctation of the aorta heard at the interscapular area
3-21e Continuous murmur in coarctation of the aorta heard in the left infrascapular
area
3-21f Rough mid-systolic murmur, early ejection sound and early blowing diastolic
murmur of aortic regurgitation
3-22a Ebstein’s anomaly with loud T1 (the “sail” sound, a split S2, a third sound in
diastoly and holosystolic tricuspid valve murmur
3-22b Tricuspid mid-diastolic murmur in Ebstein’s anomaly
3-23a Early pulmonic ejection sound, a narrowly split S2 containing a loud P2 and a
mid-systolic rough murmur
3-23b Right-sided S4, loud ejection click, rough mid-systolic murmur and a loud P2
at the third left interspace in Eisenmenger’s syndrome
3-23c Ejection sound is heard at the apex, but the loud P2 is readily transmitted to the
apex in Eisenmenger’s syndome
3-23d Associated holosystolic murmur of tricuspid regurgitation as a result of
pulmonary hypertension
3-24 The Graham Steell murmur occurs in early diastole in patients with severe
pulmonary hypertension, indistinguishable from aortic regurgitation murmur. It is
blowing, decrescendo and best heard in 2nd and 3rd left interspaces. Also heard rough
mid-systolic murmur and an early ejection sound.
3-25a Pericardial friction rub: three component rub
3-25b Pericardial friction rub: two-component rub (with ambient ICU noise)
3-25c Pericardial friction rub: rub only in ventricular systole (with ambient ICU
noise)
3-25d Pericardial friction rub: rub intensified during inspiration
3-26 Plural rub