How to Auscultate Heart Sounds

Introduction

• Purpose: Learn how to auscultate heart sounds on a real person.
• Key Focus:
  • Anatomical sites
  • Identification of S1, S2 sounds
  • Discussion on S3, S4, and heart murmurs

Importance of Auscultating Heart Sounds

• Primary Objectives:
  • Ensure rhythm is regular
  • Count the heart rate
  • Assess how heart valves are closing:
    • S1: Closure of tricuspid and mitral valves
    • S2: Closure of aortic and pulmonic valves
• Listen for extra heart sounds (S3, S4, murmurs)

Anatomical Sites for Auscultation

• Key to Finding Sites:

  • Locate clavicle
  • Find the angle of Louis (joint area)
  • Second rib below the angle of Louis

• Specific Sites:

  • Aortic Valve (Right of sternum, second intercostal space): Represents S2
  • Pulmonic Valve (Left of sternum, second intercostal space)
  • Erb's Point (Third intercostal space, midpoint between base and apex)
  • Tricuspid Valve (Fourth intercostal space, left side)
  • Mitral Valve (Fifth intercostal space, midclavicular line)

Practical Auscultation Steps

1. Preparation:

   • Remove clothing
   • Patient can be seated or lying down

2. Auscultation Technique:

   • Start with diaphragm of stethoscope
   • Auscultate from aortic area downwards (Mnemonic: All Patients Take Medicine)
   • Switch to bell to listen for murmurs and low-pitched sounds

3. Identifying Heart Sounds:

   • S1 and S2: Listen for rhythm and any splitting
   • Erb’s Point: Midway point for auscultation
   • Tricuspid & Mitral Areas: S1 louder at apex
   • Use of Bell: Listen for murmurs, S3, S4

4. Special Positions for Better Auscultation:

   • Left Lateral Position:
     • Enhances sound from the apex
     • Best for detecting S3, S4, and mitral stenosis murmurs
   • Sitting and Leaning Forward:
     • Best for aortic and pulmonic murmurs
     • Use diaphragm to detect murmurs

Tips for Differentiating S1 and S2

• S2 louder at base; S1 louder at apex
• Use carotid pulse to identify S1
• Use QRS complex on monitor for confirmation

Murmurs

• Characteristics: Blowing, swishing noise
• Grading Scale:
  • Grade 1: Hard to hear
  • Grade 6: Very loud, can be heard with chest piece lifted

Conclusion

• Understanding how to auscultate heart sounds is crucial for assessing heart health.
• Check out further detailed videos on heart sounds for additional learning.