Cardiac auscultation: Using physiologic maneuvers to further identify heart murmurs.

Auscultation of heart sounds and murmurs often is taught in a simulated environment with optimal listening conditions. Clinicians' auscultation skills can wither if they do not have contact with patients with valvular heart disease during clinical practice, or if they rely on handheld ultrasound devices or echocardiography. This article reviews heart murmurs and how to use physiologic maneuvers during the cardiac examination to assist in identifying murmurs.