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May 25, 1964


JAMA. 1964;188(8):748-749. doi:10.1001/jama.1964.03060340046012

Experience with intracardiac, epicardial, and external phonocardiography has provided alternate interpretations for the production of normal and abnormal heart sounds. Conventional areas of auscultation were chosen after correlation between the location of murmurs and necropsy findings. The present trend in cardiology is away from the anatomic and toward a description of cardiovascular hemodynamics in terms of sound physiological principles. In keeping with these altered concepts, Shah, Slodki, and Luisada1 have proposed that the areas of auscultation be renamed according to the chamber or vessel in which a given sound or murmur is best recognized by intracardiac phonocardiographic techniques. It is hoped that such revised nomenclature will encourage the clinician to think of the effect of chamber enlargement upon the location of cardiovascular sounds.

Traditionally, the apex has been designated as the "mitral" area. The murmurs of mitral stenosis and the functional rumble accompanying diastolic overload of the left ventricle

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