All of the five classic areas are auscultated - mitral area (area over the apical impulse), tricuspid area (left parasternal line, 5th intercostal space), pulmonary area (left parasternal line, 2nd intercostal space), aortic area (right parasternal line, 2nd intercostal space), and accessory aortic area (left parasternal line, 3rd intercostal space). Both the bell and the diaphragm of the stethoscope should be used. The patient should be auscultated in three positions - supine, sitting, and left lateral. Methods of auscultationĪ thorough and systematic auscultation is needed to avoid missing any subtle signs of mitral valve disease. The auscultatory findings are of significant value in the evaluation of mitral valve pathologies but these need to be considered along with history and other physical findings and investigations in diagnosing and treating these conditions. The relevant differential diagnosis of different sounds and murmurs and the way to differentiate them will also be described. The associated haemodynamics will be explained. In this article, the standard auscultatory technique will be briefly mentioned and then the typical auscultatory findings of mitral stenosis and mitral regurgitation will be described. Several acquired and congenital conditions can affect the mitral valve, leading to mitral stenosis (MS) or mitral regurgitation (MR) or a combination of both. A normal competent valve may allow a trivial amount of flow in the reverse direction, but anything more than a trace of regurgitation is considered pathologic. The mitral valve allows unidirectional unobstructed blood flow from the left atrium to the left ventricle. VSD: ventricular septal defect Introduction
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