Auscultation Location for Mitral Valve
The mitral valve is best heard near the cardiac apex, which is typically located at the fifth intercostal space at or just medial to the midclavicular line. 1, 2
Anatomic Basis for Apical Auscultation
The mitral valve's optimal auscultation point corresponds to the location where the left ventricle comes closest to the chest wall. 1 This is identified clinically as:
- Fifth intercostal space at or inside the midclavicular line 1, 3
- Point of maximal impulse (PMI) as determined by palpation 1
- The cardiac apex, which represents the most leftward and inferior point of the left ventricle 1
Clinical Findings at the Apex in Mitral Regurgitation
When examining a patient with mitral regurgitation at the apical location, you should expect:
- Holosystolic murmur in moderate to severe mitral regurgitation, radiating to the axilla 1, 4
- Late systolic murmur in mitral valve prolapse with regurgitation, often preceded by a midsystolic click 2, 5
- Pansystolic murmur heard best between the lower left sternal border and apex in clinically important mitral regurgitation 1
Why Other Locations Are Incorrect
- Right second intercostal space adjacent to sternum: This is the aortic valve area 1
- Left second intercostal space adjacent to sternum: This is the pulmonic valve area 1
- Lower left sternal border: This is the tricuspid valve area, though mitral murmurs may occasionally radiate here 1
- Lower right sternal border: This location is not a standard auscultation point for any cardiac valve 1
Practical Examination Technique
Position the stethoscope at the apex with the patient in the left lateral decubitus position to bring the left ventricle closer to the chest wall, enhancing detection of mitral valve sounds. 2 The apical four-chamber echocardiographic view corresponds to this same anatomic location, where the probe is placed at the PMI. 1