Murmurs and heart sounds

Mitral stenosis

• Tapping apex beat
• Loud first heart sound
• Rumbling mid-diastolic murmur at apex (louder in left lateral position on expiration)
• Malar flush

Aortic regurgitation

• Wide pulse pressure
• Displaced, volume-overloaded apex beat
• Early diastolic murmur at lower left sternal edge (best heard in expiration leaning forward)
• Carotid pulsation (Corrigan's sign)
• Head nodding (De Musset's sign)
• Capillary pulsations in nail bed (Quincke's sign)
• Pistol-shot heard over femorals (Traube's sign)

Mitral regurgitation

• Displaced, volume overloaded apex beat
• Soft first heart sound
• Pansystolic murmur at apex radiating to the axilla (louder in expiration)

Tricuspid regurgitation

• Large systolic 'v' waves
• Pansystolic murmur lower left sternal edge (best heard in inspiration)
• Pulsatile hepatomegaly

Aortic stenosis

• Narrow pulse pressure
• Heaving undisplaced apex beat
• Soft second heart sound
• Ejection systolic murmur heard in aortic area radiating to carotids and apex

Ventricular septal defect

• Harsh pansystolic murmur  lower left sternal edge
• Left parasternal heave