Auscultation of Heart Sounds

Introduction

Purpose: Learn how to auscultate heart sounds on a real person.
Key Topics:
- Identifying anatomical sites.
- Understanding S1, S2, S3, S4, and heart murmurs.

Rhythm and Rate: Ensure rhythm is regular and count the rate.
Valve Closure: Assess how heart valves are closing.
- S1: Tricuspid and mitral valves closing.
- S2: Aortic and pulmonic valves closing.

Key Reference Point: Find the clavicle and the angle of Louis to locate intercostal spaces.
Aortic Valve: Right side, 2nd intercostal space; represents S2.
Pulmonic Valve: Left side, 2nd intercostal space.
Erb’s Point: 3rd intercostal space; midpoint between base and apex.
Tricuspid Valve: 4th intercostal space, left side.
Mitral Valve: 5th intercostal space, midclavicular line; also known as bicuspid valve.

Preparation:
- Remove clothing for clear auscultation.
- Start with patient sitting up or lying down.
- Use mnemonic "All Patients Take Medicine" to remember order of valves.
Using Stethoscope:
- Start with the diaphragm for hearing S1 and S2 clearly.
- Listen at each valve location for normal heart sounds and any extra sounds like splits.
- S1 and S2:
  - S2 louder at base (aortic area).
  - S1 louder at apex (tricuspid and mitral areas).
Using the Bell:
- Listen for low-pitched sounds like murmurs, S3, and S4.
- Turn patient on the left side to enhance sound from the apex.
- S3: Heard after S2; sounds like "lub-dub-ta."
- S4: Heard before S1; sounds like "ta-lub-dub."
Murmurs: Listen for blowing or swishing noise, indicating a potential issue.

Leaning Forward: Helps in detecting aortic and pulmonic murmurs.
Left Side Positioning: Better for hearing apex sounds like S3, S4, and mitral stenosis murmur.

Scale: Ranges from 1 (hard to hear) to 6 (very loud, can be heard with the stethoscope lifted).

These techniques are crucial for properly assessing heart sounds and detecting any abnormalities.
Further learning resources available for deeper understanding of heart sounds.