An 85 year old woman with syncope. On examination she has a systolic crescendo decrescendo murmur heard best at the right second intercostal space though it is audible in each of the auscultation areas.

You screen a 19 year old male for a sports medical. On auscultation of the heart you are able to appreciate an early systolic ejection click followed by a crescendo decrescendo murmur heard at the 2nd intercostal space to the right of the sternum.

A 49 year old male with pectus excavatum presents with a murmur which starts out loud and gets quieter after the carotid pulse has been felt. The murmur is heard best at the mid left sternal boarder. There is a quite early systolic ejection murmur which disappears soon after the start of systole.

A 68 year old man with presents with shortness of breath which has recently worsened. On auscultation you can hear a murmur which occurs when no carotid pulse can be felt. The murmur is heard best at the fifth intercostal space in the mid clavicular line. With the diaphragm of the stethoscope applied with firm pressure you can hear a sharp snapping sound, with the bell of the stethoscope applied with light pressure you can here a quite rumbling murmur which starts around where you heard the snapping sound. The murmur terminates at the next heart sound.

A 55 year old presents for a drivers medical. On auscultation of the heart sounds you can hear a lub--da-dub sound. There are no murmurs present. The sounds are heard best at the mitral area with the person lying on the left side.

A 33-year-old male has progressive shortness of breath. You are able to auscultate a murmur which is heard best at the left 5th intercostal space. The murmur is heard while there is a carotid pulse palpable. The characteristics of the murmur are that there is an initial first heart sound followed by a short period of silence. You then hear a snap sound followed by a murmur which terminates at the second heart sound.

You assess a 75 year old male with long standing poorly controlled hypertension. You auscultate his heart sounds and you here a holosystolic murmur. There is no radiation to the carotids.

A 6 month old male presents with a snuffling cold. You are able to detect a continuous murmur.

A 29-year-old woman who has a red warm swollen leg presents to you on the acute admissions unit. On auscultation of her heart, you hear a systolic murmur which is heard best left para-sternally at the 4th intercostal space.

A 26 year old male body builder presents with a reduced ability to exercise. He has a pan systolic murmur with a split second heart sound which is unchanged on cycles of inspiration and expiration. His ECG shows an RSr pattern in lead v1.

A new born baby is presented to you and described by the consultant neonatologist as having
Ebbstine’s anomaly.