Learn normal and abnormal heart sounds and murmurs with our audio, video and text lessons. Practice drills, quizzes and an abnormal heart/lung sound reference guide. We suggest starting with the heart sounds courses and related quizzes. Begin with normal sounds, then first, second and third/fourth heart sounds, then abnormal murmurs.
Learn cardiac auscultation. These courses cover abnormal heart sounds including heart murmurs, third (S3) and fourth (S4) heart sounds and congenital conditions. Learn these sounds by selecting a topic from the table of contents below. Course and quiz certificates are available for enrolled users.
An excellent starting point for learning heart sounds. This free course provides an overview of cardiac auscultation followed by 12 lessons.Lesson List
|1||Normal Heart Sounds|
|2||Splitting Second Heart Sound|
|3||Fixed Splitting Second Heart Sound|
|4||Third Heart Sound|
|5||Fourth Heart Sound|
|7||Mid Systolic Click|
|8||Mitral Valve Leaflet Prolapse|
This free course teaches auscultation of normal sounds including split and unsplit second heart sounds heard at various heart rates and auscultation points.Lesson List
|1||First and Second Heart Sounds - Normal and Unsplit|
|2||First Heart Sound (Minimally Split)|
|3||Second Heart Sound - Physiologically Split #1|
|4||Third Heart Sound - Physiologic|
|6||Exercise - Heart Rate 120|
After learning normal heart sounds, take this first heart sounds module.Lesson List
|1||First Heart Sound - Loud|
|2||First Heart Sound (Minimally Split)|
|3||First Heart Sound (Markedly Split)|
|4||First Heart Sound - Decreased Intensity|
|5||Fourth Heart Sound Plus First Heart Sound|
|6||First Heart Sound plus Aortic Ejection Click|
Learn about second heart sounds splitting, clicks and plops.Lesson List
|1||Second Heart Sound - Physiologically Split #2|
|2||Second Heart Sound with Persistent Splitting|
|3||Second Heart Sound with Fixed Splitting|
|4||Second Heart Sound: Fixed Splitting, Increased Aortic Intensity|
|5||Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity|
|6||Second Heart Sound and Late Systolic Click|
|7||Second Heart Sound and a Tumor Plop|
|8||Opening Snap and Second Heart Sound|
|1||Third Heart Sound Gallop|
|2||Fourth Heart Sound Gallop|
|3||Third and Fourth Heart Sound Gallop|
|4||Summation Gallop at 120 beats per minute|
This systolic murmurs module includes seven lessons each with textual description, audio recording, dynamic waveform video, and a cardiac animation. Optionally, a quiz can be taken to measure comprehension and listening skills.Lesson List
|2||Aortic Sclerosis (Musical Murmur)|
|3||Aortic Stenosis -Mild|
|4||Aortic Stenosis - Severe #2|
|6||Mitral Valve Prolapse (Click with Late Systolic Murmur)|
Learn about diastolic murmurs, including regurgitation and mitral stenosis. Before you take this course you should have finished the Normal, First and Second Heart sound, and Extra Heart Sound courses.Lesson List
|1||Aortic Regurgitation - Mild|
|2||Pulmonic Regurgitation - Mild|
|3||Mitral Stenosis - Mild|
|4||Mitral Stenosis - Moderate|
|5||Mitral Stenosis - Severe|
|6||Tricuspid Stenosis - Moderate|
Ready for more advanced heart sounds? Explore complex conditions where there are murmurs in both systole and diastole. Before taking this auscultation course you should be familiar with the previous material on systolic murmurs, diastolic murmurs, extra heart sounds, etc.Lesson List
|1||Mitral Regurgitation - Severe|
|2||Tricuspid Regurgitation - Severe|
|3||Mitral Stenosis Severe and Regurgitation Mild - Rheumatic Origin|
|4||Aortic Stenosis Moderate and Regurgitation Mild - Rheumatic Origin|
|5||Mitral Regurgitation and Aortic Regurgitation|
Learn to identify sounds associated with conditions leading to sudden death. Before taking this course you should have completed the courses concerning heart sounds and murmurs and be comfortable with the material.Lesson List
|2||Aortic Stenosis - Severe #2|
|3||Arrhythmogenic RV Dysplasia|
|4||Mitral Valve Prolapse (Click with Late Systolic Murmur)|
Learn how to identify the heart sounds associated with congenital heart conditions. Before taking this course you should have completed the courses concerning heart sounds and murmurs and be comfortable with the material.Lesson List
|1||Coarctation of the Aorta|
|2||Patent Ductus Arteriosus|
|3||Atrial Septal Defect|
|4||Ventricular Septal Defect|
|5||Tetralogy of Fallot|
Improve your ability to properly refer pediatric patients to specialists. Before taking this course you should have completed our courses concerning heart sounds and murmurs and be comfortable with the material.Lesson List
|1||4-month-old girl. Failure to thrive.|
|3||4-year-old with fainting episode|
|4||10-year-old with chest pain.|
|5||6-month-old with poor appetite|
|6||12-year-old with respiratory infections|
|7||Twelve-year-old girl with periodic dizziness|
|8||Eleven-year-old girl seen after bicycle accident|
|9||Eight-year-old girl with elevated temperature|
|10||Eight-year-old boy with generalized malaise|
|11||Fifteen-year-old boy complains of dizziness|
Listen to examples of carotid bruit using six cases. Learn a method to recognize carotid bruit.Cases List
|1||70yo, annual exam|
|2||85yo, short of breath|
|3||60yo, insur exam|
|4||50yo, arm weakness|
|5||60yo, slurred speech|
|6||65yo, fainting spell|
We offer multiple types of graded quizzes, ranging from fundamentals to advanced topics. Quiz scores are saved to your personal dashboard.Auscultation Quizzes
Our auscultation reference guide includes over one hundred heart sounds. Each lesson includes text, heart/lung sounds, chestpiece location, patient position and waveform and cardiac animations.
Heart murmurs are sounds produced by turbulent blood flow, particularly from the heart's valves. They can be found in infants or develop later in life. Innocent murmurs frequently resolve without treatment. However, other abnormal heart murmurs indicate a cardiac condition.
Stethoscopes are used to listen to heart murmurs. A normal heartbeat sounds like "lub-DUB", which are the sounds of your heart valves closing. This "lub-DUB" sound changes, often with additional sounds being heard.
On this website, we provide lessons, reference guides and quizzes for cardiac auscultation of murmurs and other heart sounds. This includes gaining an understanding of cardiac rate and rhythm, conditions of the valves and possible anatomical abnormalities such as congenital defects. Links to our lessons, guides and quizzes are found in the 'Quick Links' box to the left.
Heart sounds can include multiple sound components.
Systolic murmurs occur between the first heart sound (S1) and the second heart sound (S2). Diastolic murmurs occur between S2 and S1. In addition, timing is used to describe when murmurs occur within systole or diastole. For example, early systolic, midsystolic or late systolic.
Heart sounds auscultation is performed over five locations on the anterior chest wall. Use the stethoscope's diaphragm, switching to the bell to hear lower pitched sounds.
The recommended heart murmur location on the chest wall is indicated by an icon and text within each of our lessons. Using these auscultation positions can help in evaluating the heart sound or murmur's source.
|Aortic Valve Area||Second right intercostal space (ICS), right sternal border|
|Pulmonic Valve Area||Second left intercostal space (ICS), left sternal border|
|Erb's Point||Third left ICS, left sternal border|
|Tricuspid Valve Area||Fourth left ICS, left sternal border|
|Mitral Valve Area||Fifth ICS, left mid-clavicular line|
Heart murmur duration refers to the portion of systole or diastole that the murmur occupies. Terms used include short and long. Murmurs lasting throughout systole are referred to as holosystolic or pansystolic.
Evaluation of the murmur's pitch should be made by classifying the pitch (frequency) as low, medium or high. The stethoscope's bell can be helpful with low-pitched sounds while the diaphragm is used for medium or high-pitched sounds.
Some murmurs are described by the sound's shape. Common classifications include crescendo (increasing intensity), decrescendo (decreasing intensity), crescendo-decrescendo (increasing then immediate decreasing intensity). Crescendo-decrescendo is also called diamond shaped. Rectangular, also termed plateau indicates a heart murmur of constant intensity. Our lessons include waveforms that illustrate these shapes.
Listen for additional aspects of the murmur's sounds. Heart murmurs may have qualities that can be noted as musical, harsh, blowing, booming, sharp or dull.
Respiration or patient position can influence murmur intensity as well as heart sound splitting. These factors will be described within the heart sound lessons. Generally speaking, murmurs increasing with expiration originate with left side (aortic or mitral) valves, while murmurs increasing in intensity with inspiration originate with tricuspid or pulmonary valves.
Within each lesson, the author provides a sketch of the patient's position during auscultation, such as supine, left lateral decubitus, squatting or sitting.