Sequence of Auscultating Heart Sounds in Diagnosis

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There are different sites you can auscultate to determine heart sounds. And characteristic sounds in these different regions could give us clues to pathologic cases.

Differentiating normal heart sounds.
Normally S1 is louder at the apex of the heart in the mitrial and tricuspid area and that S2 is louder near the base of the heart in the pulmonic and aortic area. The doctor listens to each sound by inching down the chest in the sequence outline below. If there is difficulty in deciding which sound is S1 or S2, especially when the rate is rapid, the carotid pulse should be simultaneously palpated with the index and middle finger while the heart sounds are auscultated. S1 is synchronous with the carotid pulse. In addition to the areas listed below, the following areas should be auscultated for sounds, such as murmurs, which may radiate to these regions: the sterno-clavicular area above the clavicles and manubrium, along the sternum and in inter-scapular region.

Sequence
Aortic area– It is located at the second right intercostals space close to the sternum of the chest. Its characteristic heart sound is S2 heard louder than S1 aortic closure heard loudest.
Pulmonic area– It is located at the second left intercostals space close to sternum. Its characteristic heart sound is splitting of S2 heard best, normally widens on inspiration; pulmonic closure heard best.
Erb’s Point– Located at the Second and third left intercostals space close to the sternum of the chest. Its characteristic heart sound is frequent site of innocent murmurs and those of aortic or pulmonic origin.
Tricuspid area– Located at the fifth right and left intercostals space close to the sternum of the chest. Its characteristic heart sound is a frequent site of innocent murmurs and those of aortic or pulmonic origin.
Tricuspid area– It is located at the fifth right and left intercostals space close to the sternum of the chest. Its characteristic heart sound is S1 heard as louder sound preceding S2 (S1 synchronous with carotid pulse).
Mitrial or apical area– It is located at the fifth intercostals space, left mid-clavicular line (third to fourth intercostals space and lateral to left mid-clavicular line in infants. Its characteristic heart sound is S1 heard loudest; splitting of S1 may be audible because mitrial closure is louder than tricuspid closure. S3 heard at beginning of expiration with child in recumbent or left side-lying position, occurs immediately after S2, sounds like word “Ken-tuc-ky” (S1-S2-S3). S4 heard best during expiration with child in recumbent position (left side-lying position decreases sound), occurs immediately before S1 sounds like word “Ten-nes-see” (S4-S1-S2).

Determination of heart sounds in children is quite complicated and very technical, but constant practice under the guidance of an experienced specialist will make this easier for you to know.

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Source by Funom Makama

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