Cardiac Auscultation and Heart Sounds

A useful cardiac examination is not a search for isolated sounds. It is a way of linking what you hear to the timing of ventricular contraction, filling, valve movement and blood flow. Start by deciding where you are in the cardiac cycle. Identify S1 and S2, listen for extra sounds, then describe any murmur by timing, pitch, location, radiation, intensity and response to respiration or preload changes. The patient’s symptoms and haemodynamic status determine urgency; the sound alone rarely provides the whole diagnosis. Auscultation remains an important bedside skill, but it is an imperfect screening test. A normal examination cannot exclude important valve disease, heart failure or critical congenital heart disease. When findings or symptoms are concerning, echocardiography and other objective testing—not repeated listening alone—settle the question.