Cardiorespiratory Auscultation for Second-Year Medical Students

CEU Universidad Cardenal Herrera

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Cardiorespiratory Auscultation Workshops

Workshops on Physiology. 2nd year of Medicine 2023/2024 Ana Checa Ros, MD, PhD Department of Medicine & Surgery ana.checaros@uchceu.es

Stethoscope Components and Sounds

Diaphragm and High-Pitched Sounds

1. STETHOSCOPE +Diaphragm High-Pitched Sounds For Example S1 and S2 Regurgitation Pericardial friction rubs ...

Bell and Medium-Low Pitched Sounds

Bell Medium-Low Pitched Sounds For Example S3 and S4 Mitral stenosis Bell Diaphragm

Cardiac Auscultation Technique

Auscultating Heart Valves

2. AUSCULTATION +Auscultate the four heart valves - A systematic routine will ensure you remember all the steps - Ask the patient to lift their breast to allow auscultation of the appropriate area if relevant.

Heart Valve Locations

Pulmonary valve Aortic valve Tricuspid valve Mitral valve Mechanical valves Biological valves

Auscultation Points for Heart Sounds

+Auscultation points Pulmonic Aortic left 2nd intercostal space right 2nd intercostal space Tricuspid Mitral lower left sternal border 4th intercostal space mid-clavicular line 5th intercostal space MTPA-5422

Physiological Heart Sounds

+Physiological heart sounds Closing of the atrioventricular valves (Mitral and Tricuspid Valves) Lub Closing of the Semilunar valves (Aortic and Pulmonary valves) Dub S1 Systole S2 Diastole

Normal Heart Sound

Physiological heart sounds NORMAL HEART SOUND

Systematic Routine for Cardiac Auscultation

1. Palpate the carotid pulse to determine the first heart sound
2. Auscultate 'upwards' through the valve areas using the diaphragm of the stethoscope whilst continuing to palpate the carotid pulse
3. Repeat auscultation across the four valves with the bell of the stethoscope

Identifying First Heart Sound

PALPATE THE CAROTID PULSE WHILST AUSCULTATING TO IDENTIFY THE FIRST HEART SOUND

Specific Valve Auscultation Areas

MITRAL VALVE FIFTH INTERCOSTAL SPACE IN THE MID-CLAVICULAR LINE TRICUSPID VALVE FOURTH INTERCOSTAL SPACE AT THE LOWER LEFT STERNAL EDGE PULMONARY VALVE SECOND INTERCOSTAL SPACE AT THE LEFT STERNAL EDGE AORTIC VALVE SECOND INTERCOSTAL SPACE AT THE RIGHT STERNAL EDGE + https://geekymedics.com/cardiovascular-examination-2/

Respiratory Auscultation

Auscultation Points for Lungs

3. RESPIRATORY AUSCULTATION +Auscultation points Front Back 1 1 1 1 2 2 2 2 3 3 3 3 4 4 5 5 4 4 5 5 6 6 7 7 6 6

Physiological Lung Sounds

• Lungs Sounds
• Vesicular Breath Sounds

Systematic Routine for Respiratory Auscultation

• 1. Ask the patient to relax and breathe deeply in and out through their mouth (prolonged deep breathing should, however, be avoided)
• 2. Position the diaphragm of the stethoscope over each of the relevant locations on the chest wall to ensure all lung regions have been assessed and listen to the breathing sounds during inspiration and expiration
• 3. Auscultate each side of the chest at each location to allow for direct comparison and increased sensitivity at detecting local abnormalities.