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medstu6

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Dear cardiologist, how can I differentiate a tricuspid murmur from mitral murmur? I did some practice today but the murmur is audible and about the same intensity to my beginner ear both at the left lower sternal boarder and at the cardiac apex. However, when I check the echo, patient has only mitral stenosis. I have tried in different position by referring my reading to distinguish the two but still I didn't appreciate a significant difference in both locations.
I have the same issue to distinguish aortic stenosis from pulmonic. I got the opportunity to listen aortic stenosis to patient too and when I listen the murmur, it is equally loud at both aortic and pulmonic area. Off course, pulmonic stenosis may be very rare but still I want to know how to differentiate these two.
I would appreciate if you could explain this to me please.

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