From the Guidelines
The best location to auscultate a heart murmur depends on the type of murmur, but generally, it is recommended to listen at the apex, lower left sternal border, or over the xiphoid process, with the patient in a supine position. When examining a patient for heart murmurs, it's essential to consider the different types of murmurs and their characteristic locations. For example, a holosystolic murmur is typically best heard at the apex, while a midsystolic murmur can be heard at the lower left sternal border or over the xiphoid process 1.
Key Locations for Auscultation
- Apex: best for holosystolic murmurs
- Lower left sternal border: best for midsystolic murmurs
- Over the xiphoid process: best for midsystolic murmurs
- Other locations may be relevant depending on the specific type of murmur
According to the guidelines for the management of patients with valvular heart disease, the presence of other physical findings, either cardiac or noncardiac, may provide important clues to the significance of a cardiac murmur and the need for further testing 1. For instance, a right heart murmur in early to midsystole at the lower left sternal border likely represents tricuspid regurgitation without pulmonary hypertension.
Importance of Patient Position and Respiration
- Patient position: supine position is generally recommended
- Respiration: having the patient take a deep breath and hold it can increase abdominal pressure and make the murmur more prominent
- Relationship to respiration and body position: important to differentiate benign physiological murmurs from pathological murmurs
It's crucial to differentiate benign physiological murmurs from pathological murmurs by noting their location, timing, and relationship to respiration and body position. The guidelines emphasize the importance of considering associated cardiac findings, such as fixed splitting of the second heart sound, to provide important information about cardiac murmurs 1.
Clinical Considerations
- Consider the type of murmur and its characteristic location
- Note the relationship to respiration and body position
- Differentiate benign physiological murmurs from pathological murmurs
- Consider associated cardiac findings to provide important information about cardiac murmurs
From the Research
Location for Auscultation of Heart Murmurs
- The location for auscultation of heart murmurs can vary depending on the type of murmur and the underlying cardiac condition 2, 3.
- For aortic regurgitation, the murmur is typically best heard at the left sternal border or at Erb's point, which is located in the third intercostal space close to the sternum 3.
- Diastolic murmurs associated with mitral valve prolapse can be best heard at the apex or left sternal border 4.
- The location of the murmur can also depend on the direction of the regurgitant jet, with some murmurs being best heard at the right second intercostal space or in the descending aorta 2, 5.