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Appendix D Recording Techniques
(Cont.)
b. By noting what happens to a sound or murmur when the bell is first applied lightly, and
then with pressure, the examiner can judge, to a certain degree, the pitch of a sound or murmur.
c. The high-pitched systolic murmur of mitral regurgitation is less likely to be affected by pressure
than medium-pitched, innocent systolic murmurs.
d. With pressure, the faint, high-pitched, systolic murmur of mitral regurgitation is less affected
than the first heart sound, and the masking effect of the first heart sound is thus diminished.
The same is true of the high-pitched, early diastolic murmur of aortic regurgitation and
accentuated second heart sound.
e. In some very noisy hearts with both systolic and diastolic (because of the amount of
sound in systole), it is difficult to be sure if there is a low-pitched diastolic murmur.
With pressure, the total sound is diminished and the low-pitched murmur diastole may
disappear. By holding the bell alternately lightly and heavily and by concentrating on diastole,
the examiner can detect the diastolic rumble.
