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a.Auscultation of carotid artery
    In carotid artery stenosis;
    systolic bruits can be heard over the bilateral carotid arteries.
    If the stenosis is severe, sustained bruits can be heard.
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jpeg b.Auscultation of the aortic area (upper)
    (2nd interspace/right margin of sternum)
    *Normally, S2 is lauder than S1 in this area.
    In aortic stenosis;
    systolic ejection murmur over the aortic area to the bilateral carotid arteries
    can be heard. In this case, bruits can be detected from right to left or from
    left to right by pressing the diaphragm surface vertical to the direction of the
    aorta.
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jpeg c. Auscultation of the aortic area (lower)
    (3rd interspace/mid to left margin of sternum)
    In aortic regurgitation:
    according to the blood flow, early systolic ejection murmur can be detected
    from right to left, and early diastolic regurgitant murmur can be detected from
    left to right as stereophonic frequency.
    (The murmurs can also be heard in the tricuspid area.) .
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d. Auscultation of the pulmonic area
    (2nd interspace/left margin of sternum)
    *S2 is louder than S1 in this area.
    *The splitting of S2 is particularly important in this area.
    Normally (physiological splitting or respiratory splitting), on inspiration,
    the S2 splits approximately 0.02 sec.
    If any disease is present, the splitting of S2 is distinguishing.
    In atrial septal defect, the fixed splitting of S2 can be detected.
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e. Auscultation of the tricuspid area
    (3rd interspace/left margin of sternum)
    *The loudness of S1 and S2 are almost same in this area.
    *The splitting of S1 and a click sound may be heard.
    In mitral stenosis, the opening snap can be heard.
    In tricuspid insufficiency, the prominent Rivero Carvallo' s sign can be detected,
    (The pansystolic murmur increases on inspiration, and decreases on expiration.)
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jpeg f. Auscultation of the mitral area
    (Cardiac apex = 5th interspace/midclavicular line)
    *In this area, S1 is louder than S2. In addition S3 and S4 can be heard.
    *For auscultation of patient, it is recommended to use the left lateral recumbent
    position and bell surface of the stethoscope.
    In mitral stenosis,
    the mid-diastolic rumbling murmur can be heard from left to right through
    auscultation by placing the left side of the bell surface upward and placing right
    side downward.
    In mitral regurgitation,
    S3 following the pansystolic murmur can also be detected.
    (Also, perform auscultation of sites such as back and lower left scapula because
    the frequency can be diffused into those areas.)
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