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The intercostal space (ICS) is the anatomic space between two ribs (Lat. costa). Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it. Since there are 12 ribs on each side, there are 11 intercostal spaces, each numbered for the rib superior to it.
An S3 heart sound is best heard with the bell-side of the stethoscope (used for lower frequency sounds). A left-sided S3 is best heard in the left lateral decubitus position and at the apex of the heart, which is normally located in the 5th left intercostal space at the midclavicular line.
The normal apex beat can be palpated in the precordium left 5th intercostal space, half-inch medial to the left midclavicular line and 3–4 inches left of left border of sternum. In children the apex beat occurs in the fourth rib interspace medial to the nipple.
The anterior divisions of the second, third, fourth, fifth, and sixth thoracic nerves, and the small branch from the first thoracic, are confined to the walls of the thorax, and are named thoracic intercostal nerves. They pass forward in the intercostal spaces below the intercostal vessels.
Posterior intercost veins that drain into the Superior intercostal vein - 2nd, 3rd, and 4th intercostal spaces. The superior intercostal vein then drains into the Azygous vein. Posterior intercost veins that drain directly into the Azygous vein - in spaces 5–11. Subcostal vein—below bottom (12th) rib and also drains into the Azygous vein.
T4 – Intersection of the midclavicular line and the fourth intercostal space, located at the level of the nipples. T5 – Intersection of the midclavicular line and the fifth intercostal space, horizontally located midway between the level of the nipples and the level of the xiphoid process.
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One may hear it at the left lower sternal border. A palpable S2 in the second left intercostal space correlates with pulmonary hypertension due to mitral stenosis. The cooing dove murmur is a cardiac murmur with a musical quality (high pitched). Associated with aortic valve regurgitation (or mitral regurgitation before rupture of chordae).