Do your auscultation in a quiet room, forpractical reasons that you can hear the heartsounds better.
Use the bell for the low-pitched sound. (e.g. S3,S4)
Bell with an L is for
sound;Diaphragm with an H is for
Examine the patient in 3 positions.
Left lateral decubitus
S3, if you
can’t find the apex beat,
if you turn the patient in this positionthen you can maximize the contactbetween the left ventricle and the chestwall-
When palpating the patient, what youfeel is the vibration of the heart to thechest wall-
Exaggerates the apex beat and theheart sounds
Exaggerates the murmurs found in thebase
>referring to the pulmonic area,aortic area and the S2
he “inching” technique
Move the stethoscope inch by inch and nottoo fast from different auscultatory areas so
that you won’t miss any sound in between
(from the apex or mitral to the tricuspidarea)
Listen to one event at a time.
At first, try to listen the heart sound in theapex then listen to the
first heart sound
because it is maximal at the
Concentrate on one heart sound at a time
Listen to whatever there is between the 1
Listen to interval between 1
sounds,listen to any extra heart sounds (e.g.murmur).
- Pulmonic Area: left side, 2
ICS, swallow- Aortic Area: right side, 2
ICS; radiation of thesound towards the ascending aorta- Mitral Area: Apex, below the nipple; 5
ICSbisected by the midclavicular line- Tricuspid: left side, 4
FIRST HEART SOUNDS (S1)
Caused by closure of mitral and tricuspidvalve. There will be motion of blood,chordae tendinae and papillary muscles.
This coincides with
(contraction of ventricles,
closure of MV and TV
First heart sound heard,
This is best heard over the
(intensityat the base is decreased).
Intensity is affected by
strength andcontractility of the ventricle
prior to closure.
E.g TachycardiaS1 is loude
because the valves arewidely open and tends to close again
Short PR interval
because the px tends to betachycardic
increased metabolism;a.k.a. hyperthyroidism
increased metabolism,faster HR; increased pressure in leftatrium
Subject: Physical DiagnosisTopic: Physical Examination for CVS 2Lecturer: Dr. Jaime PacificoDate of Lecture: 09.09.11Transcriptionist: Mating Cats
S Y 2 0 1 1 - 2 0 1 2