Many cardiologists are not able to perform effective cardiac auscultation and helpless without ultrasound. Sad but true. But some simple skills can significantly improve the situation. In the nearest future, I hope to publish my book which will simplify the development of these skills, one of which I called 'chronological localisation'. This skill is vital. Heart auscultation just does not exist without it.
Fortunately, you need to memorise very little logical information. Later, practice this skill. More in the slideshow.
This is a part of my book which will appear soon.

It seems that the most common pathologic sign in cardiac auscultation is fourth heart sound S4. When I was learning heart auscultation many years ago, it was hard to me to understand and hear S4 because of its close proximity to first heart sound S1.
S4 corresponds to atrial contraction. It is probably always abnormal sign. You could imagine sequence S4-S1 like stairs with two steps: the first step is S4, the second one is S1. S4 is a lower step and S1 is an upper one. S4 consists of low frequencies only, S1 contains low and high frequencies. Imagine stairs with two steps when you hear S4.

Very frequently Acute MI is associated with loud S4. Here is an example. Use headphones for better hearing.

The case which I will describe now has two fascinating features. Firstly, accurate auscultation led to correct diagnosis, while high technology imaging tests performed previously missed significant lesion. Secondly, the auscultatory picture was very bright, and its careful analysis is edifying. 

There are many different stethoscopes on the market. Some of them are cheap, others are very expensive.. You can buy conventional or digital stethoscope. Your ability to hear heart sound depends on the quality of your stethoscope. Your stethoscope can be used for many years.
So, to choose a stethoscope is like to choose a friend. In this video we will give you some necessary advice.