MRCP UK EXAMINATIONS

Detailed explanation-1: -For example, the S1 heart sound-consisting of mitral and tricuspid valve closure-is best heard at the tricuspid (left lower sternal border) and mitral (cardiac apex) listening posts.

Detailed explanation-2: -Mitral murmurs are best heard at the apex and radiate to the axilla. Mitral sounds can be accentuated with the patient in the left lateral position. Hence, to listen to a mitral murmur, first listen to the apex, then listen round to the mid-axillary line at the same level.

Detailed explanation-3: -The aortic ejection sound is best audible at the apex or the aortic area. The pulmonary valve ejection sound is best audible at the pulmonary area. The aortic valvular ejection sound is associated with bicuspid aortic valves and aortic regurgitation.

Detailed explanation-4: -The loud S1 is due primarily to greater excursion of the leaflets during closure, since elevated left atrial pressure has kept the leaflets relatively wide apart.

Detailed explanation-5: -Normally, S1 is louder than S2 at the apex, and softer than S2 at the base of the heart. Pathologic changes in the intensity of S1 relative to S2 may be seen in certain disease states. When evaluating the intensity of S2, note the relative intensity of the aortic component (A2) and the pulmonic component (P2).