Nurses are increasingly undertaking additional roles, and auscultation often forms part of the complete patient assessment. This compliments other clinical examination skills and consultation. Further tests are available to assist in informing diagnostic and management options. Repeated exposure increases confidence and aids the practitioner in his or her assessment of the patient. Valvular heart disease can affect any of the four heart valves but, more commonly, the aortic or mitral valve becomes stenotic or regurgitant. Heart sounds can be distinguished by the timing, intensity, duration and pitch, and murmurs can be physiological or pathological.