Aortic stenosis is an ejection systolic murmur which is loudest over the aortic area and radiates to the carotids. The cardiac examination takes time. In valvular heart disease, pay attention to signs other than the murmur (e.g. character of the peripheral pulse and apex beat and association of differences in pulse pressure). It is possible that the doctors may know the diagnosis before they listen to the chest. Aortic regurgitation is an early diastolic murmur which is heard loudest over the left sternal edge with the patient sitting forward. Hypertrophic cardiomyopathy (HCM) is associated with an ejection systolic murmur heard loudest at the left sternal edge. Key clinical findings are a bifid jerky pulse, a double apical impulse and a palpable thrill. This is an autosomal dominant inherited condition which is associated with sudden cardiac death. Mitral stenosis is a mid-diastolic murmur which is heard loudest at the apex in the left lateral position.