Cardiac Auscultation By Jessica I Gupta, MD, University of Michigan Health; Michael J Shea, MD, Michigan Medicine at the University of Michigan Reviewed / Revised Mar 2023 View Patient Education Topic Resources Split First Heart Sound Pulmonary Ejection Click Split Second Heart Sound Split Second Heart Sound... Split Second Heart Sound... Split Second Heart Sound... Third Heart Sound Fourth Heart Sound Summation Gallop Diastolic Knock Mitral Valve Opening Snap Aortic Stenosis Murmur Pulmonic Stenosis Murmur Mitral Regurgitation Murmur Ventricular Septal Defect... Patent Ductus Arteriosus... Pericardial Friction Rub Diagram of physical findings... Heart Murmur Intensity Etiology of Murmurs by Timing Maneuvers That Aid in Diagnosis... Auscultation of the heart requires excellent hearing and the ability to distinguish subtle differences in pitch and timing.