This podcast examines auscultation of the murmur of congenital ventricular septal defect (VSD). The murmur of congenital ventricular septal defect (VSD) is frequently accompanied by a thrill, and along with the thrill, is best appreciated at the lower left sternal border at the fifth, fourth, and third intercostals spaces. Copyright 2011 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

This podcast examines auscultation of murmurs associated with hypertrophic obstructive cardiomyopathy (HOCM) and LV outlet obstruction. Copyright 2011 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

A large left atrial myxoma produces a diastolic sound that is referred to as a tumor plop. This sound arises from obstruction to ventricular in-flow that occurs as the tumor comes to rest over the mitral annulus. It is the functional equivalent of mitral valve stenosis and may be associated with a low frequency diastolic murmur. Copyright 2011 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

The early diastolic sound of pericardial constriction occurs slightly earlier than the average third heart sound. Its frequency is somewhat higher, allowing you to hear it throughout the precordium using the diaphragm and the bell. Common causes of pericardial constriction include prior cardiac surgery and uremic pericarditis. Copyright 2011 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

Auscultation of the fixed splitting of the second heart sound, a finding on physical examination very specific for atrial septal defect. Copyright 2010 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

Auscultation of the wide splitting of the second heart sound, commonly caused by right bundle branch block (RBBB). Copyright 2010 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

Auscultation of paradoxical splitting of the second sound, opposite of the normal or physiological finding. Copyright 2010 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

Auscultation of physiological splitting of the second heart sound. Copyright 2010 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

Auscultation of tricuspid insufficiency and its resulting regurgitation. Copyright 2010 by the Texas Heart Institute at St. Luke's Episcopal Hospital.

Auscultation of the fourth heart sound (s4). Copyright 2010 by the Texas Heart Institute at St. Luke's Episcopal Hospital.