Notes on Heart Examination

Examination Process:

1. Chest and Neck Examination:

   • Listening to the heart sound and pulse in the neck.
   • Monitoring the carotid pulse while listening.

2. Sites for Heart Sounds Auscultation:

   • Mitral Valve: Fifth intercostal space at the midclavicular line on the left.
   • Tricuspid Valve: Fourth intercostal space on the left.
   • Pulmonic Valve: Second intercostal space on the left.
   • Aortic Valve: Second intercostal space on the right.

3. Using the Bell of the Stethoscope to Listen:

   • Searching for any radiation or murmur.
   • For instance, the systolic murmur that can be heard extending above the carotid arteries.

Patient Instructions:

1. Patient Position:

   • Sitting with the back raised.
   • Taking a deep breath and exhaling, then holding the breath.

2. Normal Listening:

   • Resting on the left side.

3. Enhancing the Mitral Sound:

   • The mitral sound increases with exhalation.
   • Taking a deep breath, holding it, then breathing normally.

4. Searching for Mitral Radiation:

   • Listening under the armpits.