But starting from Apex and proceeding with Tricuspid (LLSB), Aortic & Pulmonic areas is easy to practice. There is no standard order for auscultation. You should firmly press your “diaphragm” to chest wall whereas apply only light pressure when you are auscultating with the “bell” of your stethoscope. Apart from the 3rd and 4th heart sounds and the mid-diastolic murmur of Mitral Stenosis, all the other heart sounds are best heard with the diaphragm of your stethoscope. Use your stethoscope for cardiac auscultation. Some cardiac sounds can be heard with the unaided ear (e.g. Tricuspid Area (Left 5 th Intercostal Space, Sternal Border).Auscultation for heart sounds is mainly done in 4 areas, namely Mitral, Tricuspid, Aortic & Pulmonic. Remember these areas do not correspond to the location of heart valves, but the areas where the cardiac sounds are best heard. Mitral Area (Left 5 th Intercostal Space, Mid Clavicular Line). Pulmonary Valve Closure:- Sound travels into the Pulmonary Artery (since the Right Ventricle is in Diastole) and is heard where the Pulmonary Artery is near to the pericardium Pulmonary Area i.e., 2 nd Intercostal Space at the Left Parasternum.Īreas on the Precordium for Auscultation for a specific Sound S-1.Aortic Valve Closure:- Sound travels into the Aorta (since the Left Ventricle is in Diastole) and is heard where Aorta is near to the pericardium Aortic Area i.e., 2 nd Intercostal Space at the Right Parasternum.Tricuspid Valve Closure:- Sound travels into the Right ventricle and is heard where its wall touches the pericardium Tricuspid Area i.e., 4 th Intercostal Space at the Left Parasternum.Mitral Valve Closure:- Sound travels into the Left Ventricle and is heard where the ventricle wall touches the pericardium Mitral Area i.e., 5 th Intercostal Space at the Mid-Clavicular Line.

The areas of the heart sounds being heard do not represent the actual presence of the valves but are due to transmission of the sounds.Īs sounds always get transmitted easily through a high pressure system, the sounds produced by the closure of valves travel through the blood which is into a High Pressure Area (which is also the direction of Blood Flow). In a perfectly normal heart, we observe two distinct sounds and rarely two other sounds. The standard description of Heart Sounds, “LUB” “DUB” are not merely two sounds, but divide the function of heart into phases and when interpreted logically (with added sounds), we can get to a conclusion whether the Heart is Normal or Diseased. Rubbing of two surfaces (as in Pericardial Diseases hears as Pericardial Rub).Flow of blood through a defect in the valve or wall (as in Valvular or Septal Diseases hears as Murmurs).Closure of valves (as heard over the precordium from a normal Heart).Constriction of the blood vessel (due to turbulent flow as the principle used in measuring Blood Pressure, Arterial Bruit or Venous Hum).Arterial (for measurement of Blood Pressure) and Venous Sounds.Īny sound in the circulation is created due to:.Sounds produced in the body caught by the stethoscope: Later in 1900’s, was devised the modern stethoscope, by Dr. Rene Laennec introduced the “ Stethoscope” (Chest Scope), rolled paper which funneled the sounds from the chest wall to the ear. It was then an unaided auscultation (i.e. Areas on the Precordium for Auscultation for a specific SoundĪuscultation (to listen), a clinical procedure done on a daily basis as an aid in diagnosing many disorders, dates back centuries since the Egyptians.

Heartbeat sound