Graphic representation of common heart murmurs. Table 1–2 shows abbreviations and descriptions. Height of box indicates intensity of heart sound;
hatched lines indicate pattern of murmur. S1: Occurs at beginning of systole and is closure of the mitral (M1) and tricuspid (T1) valves. Normally, T1 is
heard only at the LLSB. S1 is loudest at the apex. S2: Occurs at end of systole and is closure of the aortic (A2) and pulmonic valves (P2). P2 is best heard
at the L second ICS. S2 is loudest at R second ICS. The L second ICS is where to listen for splitting of A2 and P2. At end inspiration with tidal breathing
there is more pronounced splitting of the A2 and P2 sounds (they are farther apart than at end expiration). With normal physiology M1 occurs before T1;
A2 occurs before P2.
Source: Chapter 1. History and Physical Examination, Clinician's Pocket Reference: The Scut Monkey, 11e
Citation: Gomella LG, Haist SA. Clinician's Pocket Reference: The Scut Monkey, 11e; 2007 Available at: http://mhmedical.com/ Accessed: July
28, 2017
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