Auscultation of the heart

Auscultation is performed at quiet respiration, when the patients does not breathe, at the height of the expiration and inspiration, in a lying and upright position, on the left side, and after dosed physical load.

The consequence of listening is determined by the incidence of the diseases of the respective structures: most frequent are the affections of the left ventricle, mitral valve, aortic valve, right ventricle, tricuspid valve and pulmonary artery valve. When necessary, other regions can be listened to, e.g. the place of sound conduction, but this is done after the standard auscultation.

Points of heart auscultation:

a) Point 1 - at the area of the heart apex - mitral valve;

b) Point 2 - at the 2 interspace on the right near the edge of the breastbone - aortic valve;

c) Point 3 - at the 2^nd interspace on the left near the edge of the breastbone - pulmonary artery valve;

d) Point 4 – at place of xiphoid process origin - tricuspid valve.

e) Point 5 (Botkin-Erb) is listened at the 3^rd intercostal space at the left edge of the breastbone. These positions are associated with the projection of the aortic valve on the precordial area. It is the place where acoustic phenomena developing at the beginning of diastole, especially when the cusps of the aortic valves are not closed (diastolic sound of blood regurgitation), are well heard.

In healthy adults the heart melody consists of two sounds (first and second), this is divided by two pauses (systolic and diastolic).

Firstly assess the rhythm of the heart activity. Then – heart sounds and murmur.

Heart sounds are short acoustic phenomena resulting from tissue vibration, which occur at vibrations of strained muscles of the ventricles and valve cusps. The first sound (systolic) is heard at the beginning of systole, the second heart sound (diastolic) is heard at the beginning of diastole.

The first and second sounds are heard over the whole precardiac area, but the cardiac melody differs in different auscultation points: the first sound is better heard in points 1 and 4, the second one in points 2, 3, 5. There are other features which allow to distinguish the first and second heart sounds: the first sound is longer, the frequency of vibrations is lower.

The first sound is heard at the beginning of a short pause (systole), it coincides with the apical pulse and pulsation of the carotid arteries.

If your hear sounds without repeating like short and long pauses melody patient has irregular heart activity. But if you hear sounds with regular repeated short and long pauses patient has regular heart activity.

Heart murmurs

Heart murmurs are prolonged acoustic phenomena produced by the working heart. They are divided into two groups: extracardiac and intracardiac.

Extracardiac murmurs are pericardial friction rub and cardiopulmonary murmurs. Intracardiac murmurs develop inside the heart and large vessels. Depending on the cause the murmurs are divided into organic (valvate), functional and organ-functional (muscular).

The following properties of the murmur have diagnostic significance:

- association of the murmur with the phase of the cardiac cycle (systolic, diastolic);

- the area where it is heard best (heart apex, 2^nd intercostal space to the right and left of the sternum, basis of the xiphoid process);

- direction of the murmur radiation (axillary area, cervical vessels, subscapular area);

- loudness, duration of the murmur;

- the timber of the murmur (blowing, sawing, scratching, musical);

- relation of the murmur and the sound after which it is heard (merges with the sound, separated from it);

- if the murmur increases or decreases during the pause;

- influence of the position, physical exercise, phases of respiration.

Дата добавления: 2015-11-14