Practical · 14. Heart auscultation. Heart sounds and murmers
Walks through the setup for heart auscultation, including room conditions, patient position and when to use the diaphragm or bell of the stethoscope. It lists the four valve listening areas, then identifies S1 to S4 by timing and location. It closes with how systolic and diastolic murmurs are timed, the positions that help detect specific murmurs, and a summary table of four murmurs with their location, radiation and quality.
Topic 71 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 3 sections, about 300 words (3 min of reading), with 14 flashcards.
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Heart auscultation. Heart sounds and murmers
Steps for Auscultation:
Important Auscultation Points:
Steps for Auscultation:
1. Quiet Environment:
Ensure the room is quiet to hear heart sounds clearly.
Have the patient in a relaxed, supine position.
2. Stethoscope Use:
Diaphragm: Use for high-pitched sounds (e.g., S1, S2, murmurs).
Bell: Use for low-pitched sounds (e.g., S3, S4, some murmurs).
3. Auscultation Areas:
Aortic Valve: 2nd ICS, Right Sternal Border (RSB).
Pulmonary Valve: 2nd ICS, Left Sternal Border (LSB).
Tricuspid Valve: 4th ICS, Left Sternal Border (LSB).
Mitral Valve (Apex): 5th ICS, Midclavicular Line (MCL).
4. Heart Sounds Identification:
S1 (First Heart Sound):
Occurs at the start of systole.
Caused by the closure of the mitral and tricuspid valves.
Loudest at the apex.
S2 (Second Heart Sound):
Occurs at the end of systole, start of diastole.
Caused by the closure of the aortic and pulmonary valves.
Loudest at the base of the heart (2nd ICS, RSB).
S3 (Third Heart Sound):
Occurs early in diastole (after S2).
Associated with heart failure, increased ventricular filling pressure.
Best heard at the apex with the bell.
S4 (Fourth Heart Sound):
Occurs late in diastole (before S1).
Associated with stiff ventricles (e.g., left ventricular hypertrophy).
Best heard at the apex with the bell.
5. Detecting Murmurs:
Systolic Murmurs: Occur between S1 and S2.
Example causes: Aortic stenosis, mitral regurgitation.
Diastolic Murmurs: Occur after S2.
Example causes: Aortic regurgitation, mitral stenosis.
6. Patient Positioning to Enhance Murmur Detection:
Left Lateral Position:
Helps better hear mitral stenosis (use the bell at the apex).
Sitting Forward, Exhale:
Best for hearing aortic regurgitation (use the diaphragm at the left sternal border).
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