Auscultation of the heart

Purposes:

Assessment of heart rhythm

Auscultation of heart sounds

Auscultation of heart murmurs

Auscultation of the heart

Process of Auscultation

At each auscultatory area:

1.Concentrate on 1st Heart Sound

•note Intensity and Splitting

2.Concentrate on 2nd Heart Sound

•note Intensity and Splitting

3.Listen for Extra Sounds in Systole

•note Timing, Intensity, Pitch

Process of Auscultation

4.Listen for Extra Sounds in Diastole

•note timing, intensity, pitch

5.Listen for Systolic Murmurs

6.Listen for Diastolic Murmurs

7.Other Heart Sounds

S1 (systolic )

•Appears during isovolumetric contraction

•Best heard: apex (mitral valve) and LLSB (tricuspid valve): S1 is louder then S2

•Appears in early systole after long pause

•Fits in with apex beat and carotid pulse

•Is long

Components of S1

•Valvular

•Muscular

•Vascular

•Atrial

Factors that may influence the intensity of S1

•Condition of the valves

•Condition of ventricles (velocity of ventricular contraction)

–Metabolic processes in myocardium

–Left ventricular systolic volume

•Thickness of the valves

•Position of atrioventricular valves before isovolumetric contraction

S2 (diastolic)

•Appears in early diastole of the ventricles

•Best heard on the base (S2 is louder then S1)

•Short

•Doesn`t fit in with apex beat

Components

•Aortic (A2)

oValvular, vascular

•Pulmonary (P2)

oValvular, vascular

Factors that may influence the intensity of S2

•Condition of the valves

•Blood pressure level in aorta and pulmonary trunk

•Speed of ventricular relaxation

•Thickness of the valves

Differences between S1 and S2

Short systolic pause between S1 and S2;

Long diastolic pause between S2 and S1;

Best point for auscultation of S1 is apex and low border of the sternum;

Best point for auscultation of S2 is the 2nd intercostal space to the right and to the left