Sit up, lean forward, and have patient exhale: Listen with the diaphragm at the aortic and pulmonic sites for murmurs.Left side: turn the patient onto their left side and auscultate with the bell of the stethoscope at the APEX area and listen for S3, S4, or mitral stenosis murmurs.Then repeat with the bell of the stethoscope…noting any other extra sounds. Supine or sitting-up: Use the diaphragm and listen at all 5 auscultation sites (noting S1 and S2 and if there are any splits presents).Patient Positioning for Heart Auscultation S3 and S4 along with mitral stenosis murmurs will be heard best at this position with the patient lying on their left side with the bell of the stethoscope. The Apex of the heart includes the tricuspid and mitral areas, and S1 will be loudest at the apex. Aortic and pulmonic murmurs are heard best at the base with the patient leaning forward and sitting up with the diaphragm of the stethoscope. The Base of the heart includes the aortic and pulmonic areas, and S2 will be loudest at the base. Mitral: found left of the sternal border at the midclavicular in the 5th intercostal space REPRESENTS S1 “lub” (also the site of point of maximal impulse) Tricuspid: found left of the sternal border in the 4th intercostal space REPRESENTS S1 “lub” Pulmonic: found left of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub”Įrb’s Point: found left of the sternal border in the 3rd intercostal space Memorize the information below because it is crucial in understanding heart sounds and which valve represents each sound.Īortic: found right of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub” This represents the order of how you will auscultate the heart. Remember the mnemonic “ All Patients Take Medicine”. S2 split: Aortic and pulmonic valves closing asynchronously.S1 split: Tricuspid and mitral valves closing asynchronously.However, in some people these valves may close asynchronously and this would cause a split in sound. Normally, the AV valves close at the same time and the same is true for the SL valves. The second sound you hear is S2 and is caused by the closure of the s emilunar valves (SL) AORTIC AND PULMONIC VALVES. The first sound you hear is S1 and is caused by the closure of the atrioventricular valves (AV) TRICUSPID AND MITRAL VALVES. Heart sounds are caused by the closure of heart valves. Bell: use for listening to LOW PITCHED sounds like S3, S4, and mitral stenosis murmurs.Diaphragm: use for listening to HIGH PITCHED sounds like S1, S2, and aortic/pulmonic murmurs.
LISTENING TO HEART SOUNDS HOW TO
Goal: to assess the closure of the heart valves ( Aortic, Pulmonic, Tricuspid, Mitral “Bicuspid”) Basics about Stethoscope Usageīefore you listen to heart sounds you must know how to use your stethoscope’s chest piece properly. Anatomy of the heart and blood flow (video)ĭon’t forget to take the heart sounds quiz when you are done reviewing Lecture on Heart Sounds.
Also, be sure to watch the lecture below to help you learn heart sounds. In this article, I am going to highlight the most important things you must know about heart sounds.
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