Auscultation of Heart Sounds | Assessing Heart Sounds | Listening to the Heart with a Stethoscope
Summary
TLDRIn this educational video, Sarah from Register Nurse Orion Comm teaches viewers how to auscultate heart sounds. She demonstrates the process on a real person, explaining the significance of S1 and S2 sounds, which correspond to the closure of the heart's valves. Sarah provides anatomical landmarks for accurate auscultation and discusses additional heart sounds like S3, S4, and murmurs. She offers tips for distinguishing between sounds and the importance of patient positioning to detect subtleties in heart sounds, concluding with a guide on how to identify and grade heart murmurs.
Takeaways
- 👂 The purpose of auscultating heart sounds is to assess the heart's rhythm, rate, and the closure of heart valves.
- 📍 Heart sounds are associated with specific valves: S1 with tricuspid and mitral valves, and S2 with aortic and pulmonic valves.
- 📌 Anatomical sites for auscultation include the aortic area, pulmonic area, the apex (heart's base), and the mitral area.
- 🔍 Auscultation begins by finding the clavicle, angle of Louis, and the second intercostal space to locate the valves.
- 👆 The aortic and pulmonic valves close together, producing the louder S2 sound, usually heard at the base of the heart.
- 👇 The tricuspid and mitral valves close simultaneously to produce S1, typically louder at the apex.
- 🎧 Using a stethoscope, start with the diaphragm to hear S1 and S2 clearly, then switch to the bell to listen for murmurs.
- 🔊 S2 is louder at the base, and S1 is louder at the apex, which helps in distinguishing between the two sounds.
- 🛏️ Positioning the patient differently, such as on their left side, can help in identifying additional heart sounds like S3 and S4.
- 👂🏼 Auscultation for S3 and S4 involves listening at the apex with the bell of the stethoscope, as these sounds are low-pitched.
- 📊 Heart murmurs are extra sounds that may indicate issues with blood flow through the heart valves and should be graded if present.
Q & A
What is the primary purpose of auscultating heart sounds?
-The primary purpose of auscultating heart sounds is to assess the regularity of the heart rhythm, count the rate, and evaluate the function of the heart valves by listening to the sounds they make when closing.
What are the two main heart sounds, S1 and S2, associated with?
-S1 is associated with the closing of the tricuspid and mitral valves, while S2 is associated with the closing of the aortic and pulmonic valves.
How can you locate the anatomical sites for auscultating heart sounds on a patient?
-To locate the anatomical sites, find the clavicle on the patient, then go down to find the angle of Louis, where the second rib comes out. The right side of this border is the aortic valve, and the left side is the pulmonic valve. The tricuspid valve is found in the fourth intercostal space, and the mitral valve is found in the fifth intercostal space at the mid-clavicular line.
What is the significance of the point of maximal impulse (PMI) in auscultation?
-The point of maximal impulse (PMI) is significant because it is where the heart's contraction is most easily felt and heard, typically located at the mitral valve area, and can help in identifying the location for auscultation.
What is the mnemonic 'ALL PATIENTS TAKE MEDICINE' used for in auscultation?
-The mnemonic 'ALL PATIENTS TAKE MEDICINE' is used to remember the order of auscultation sites: Aortic, Left sternal border (mid-clavicular line), Pulmonic, Apex, and Mitral, which helps in systematically assessing the heart sounds.
Why is it important to differentiate between S1 and S2 when auscultating heart sounds?
-Differentiating between S1 and S2 is important because it helps in identifying the specific valves that are closing, which is crucial for diagnosing any abnormalities in heart valve function.
What are some tips for distinguishing between S1 and S2 sounds?
-S2 is typically louder at the base of the heart, while S1 is louder at the apex. Additionally, feeling the carotid pulse while listening to the apex can help identify S1, as the sound coincides with the pulse. Observing the QRS complex on a bedside monitor can also help, as S1 occurs with the spike of the QRS complex.
Why is the patient positioned on their left side during auscultation?
-Positioning the patient on their left side helps because most of the heart is on the left side, and turning them to that side allows the heart to move over slightly, making it easier to hear the anatomical sites, especially the apex.
What are S3 and S4 heart sounds, and why are they significant?
-S3 and S4 are extra heart sounds that can be heard in certain conditions. S3 is a sound heard just after S2 and may be normal in children and young adults but can indicate heart problems in older adults. S4 is heard just before S1 and is not typically present in a normal heart, indicating a possible issue when heard.
How can auscultation help in identifying heart murmurs?
-Auscultation can help identify heart murmurs by listening for blowing or swishing noises, which may indicate turbulent blood flow due to valve issues. The patient may be asked to lean forward and exhale to enhance the sounds, and the diaphragm of the stethoscope is used to pick up these murmurs at the aortic and pulmonic areas.
What is the grading scale for heart murmurs, and what does it indicate?
-The grading scale for heart murmurs ranges from one to six, with grade one being hard to hear and grade six being so loud that the stethoscope can be lifted off the chest and the murmur can still be heard. The grading indicates the intensity of the murmur, which can help in assessing the severity of the underlying condition.
Outlines
👂 Introduction to Auscultating Heart Sounds
Sarah from RegisterNurseOrion Comm introduces a tutorial on auscultating heart sounds. She plans to demonstrate how to listen to heart sounds on a real person, focusing on identifying the anatomical sites and differentiating between the sounds of the heart valves closing, such as S1 and S2. S1 is produced by the closure of the tricuspid and mitral valves, while S2 is the sound of the aortic and pulmonic valves closing. The tutorial will also cover extra heart sounds like S3, S4, and heart murmurs, and will explain the importance of assessing heart rhythm and rate.
📍 Locating Anatomical Sites for Heart Auscultation
Sarah explains the process of locating the anatomical sites for heart auscultation, starting with finding the clavicle and the angle of Louis, then identifying the intercostal spaces where the heart valves are located. She describes the positions of the aortic and pulmonic valves at the base of the heart, which are responsible for the S2 sound, and the tricuspid and mitral valves, which produce the S1 sound. She also mentions the point of maximal impulse and the distinction between the apex and the base of the heart. Sarah then demonstrates the correct placement of the stethoscope's chest piece on a patient to listen for S1 and S2, and discusses the importance of distinguishing between these sounds and looking for any splits in the sounds.
🔍 Advanced Techniques for Heart Sound Auscultation
In this part, Sarah covers advanced techniques for auscultating heart sounds, including using the bell of the stethoscope to listen for low-pitched noises like S3 and S4, and murmurs. She explains how to position the patient to better hear these sounds, such as turning them onto their left side to push the heart towards the chest wall. Sarah also provides tips for differentiating between S1 and S2 sounds, such as their relative loudness at the base and apex of the heart, and using the carotid pulse as a reference. She concludes with a demonstration of how to listen for murmurs with the patient leaning forward and exhaling, and explains the grading scale for murmurs, from barely audible to those that can be heard without a stethoscope.
📺 Conclusion and Additional Resources
Sarah concludes the tutorial by inviting viewers to watch another in-depth video about heart sounds, presumably available through a pop-up card on the screen. She thanks the viewers for watching and encourages them to subscribe to the YouTube channel for more educational content.
Mindmap
Keywords
💡Auscultation
💡Heart sounds
💡S1 and S2
💡Heart valves
💡Anatomical sites
💡Murmurs
💡Stethoscope
💡Point of maximal impulse (PMI)
💡Carotid artery
💡QRS complex
💡Mitral valve
Highlights
Sarah from Register Nurse Orion Comm demonstrates how to auscultate heart sounds on a real person.
The purpose of listening to heart sounds is to ensure the rhythm is regular, count the rate, and assess heart valve closures.
S1 and S2 represent the closing of tricuspid and mitral valves, and aortic and pulmonic valves, respectively.
Anatomical sites for auscultation include the aortic, pulmonic, tricuspid, and mitral valves, and the apex of the heart.
Finding the clavicle and the angle of Louis helps identify the correct auscultation sites on the chest.
The base of the heart is where S2 is most prominently heard, while S1 is louder at the apex.
Auscultation begins with the patient sitting or lying down, using a stethoscope diaphragm first.
Mnemonic 'all patients take medicine' helps remember the auscultation order: aortic, pulmonic, tricuspid, mitral.
Listening for S1 and S2 involves distinguishing the sounds and checking for splits in valve closures.
Differentiating S1 from S2 can be aided by their loudness at the base and apex, respectively.
Feeling the carotid pulse can help identify S1 as it coincides with the pulse.
Turning the patient to their left side enhances the audibility of the apex, important for detecting S3, S4, and murmurs.
The bell of the stethoscope is used to listen for low-pitched sounds like S3, S4, and heart murmurs.
S3 and S4 are extra heart sounds heard after S2 and before S1, respectively.
Auscultation also includes having the patient lean forward and exhale to detect aortic and pulmonic murmurs.
Heart murmurs are graded on a scale from one to six, with six being the loudest.
A thrill, a vibration on the skin, can also indicate the presence of a heart murmur.
Sarah encourages viewers to watch her in-depth video on heart sounds for further familiarization.
Transcripts
hey everyone it's sarah with register
nurse Orion comm and in this video I'm
going to be going over how to auscultate
heart sounds what I'm going to be doing
is I'm going to show you how to listen
to heart sounds on a real person I'm
going to show you the anatomical site
how to identify s1 s2 talk about those
s3 s4 heart murmurs those extra sounds
you may hear the first let's covered the
basics okay why do we listen to heart
sounds what is the purpose well one
thing is we want to make sure the rhythm
is regular we want to count the rate but
we're also one of the big things is that
we're assessing how those heart valves
are closing because whenever you are
hearing s1 s2 those are valves valves
closing s1 are your tricuspid and mitral
valves closing and s2 is the sound of
your aortic and pulmonic valves closing
and while you're listening to heart
sounds you'll be trying to distinguish
am i hearing s1 s2 and then you're going
to be positioning the patient a little
bit different positions and going to be
listening for those extra heart sounds
like s3 s4 and heart murmurs so first
let's go over the anatomical sides here
in a second you're going to see what it
actually looks like whenever and you're
looking at the anatomical sites on the
chest but let me cover them real fast if
you want you can write this down so you
can remember it the key to help you
identify these anatomical sites is to
find the clavicle on the patient and
then go down and find the angle of Luis
the joint little area and the second rib
comes out from there and right below
that we're going to start on the right
side is intercostal space and right
there left I mean right of that border
is the aortic valve and the aortic valve
represents when it closes the sound of
s2 that in the pulmonic valve normally
close together so when they close
together they're similar looner valves
you will hear s2 then right over on the
left side in the same space
second intercostal space you will find
the pulmonic valve then down in the
third space you will find herbs point
and this is just an area where you're
separating the base from the apex it's
just the midway point between those two
areas and then you have the fourth
intercostal space which right next to
the border of that is the tricuspid
valve you'll find that on the left side
as well and the tricuspid and mitral
valves when they close together
simultaneously you will hear s1 and they
are filling the base then you go down a
little bit in the fifth intercostal
space but mid clavicular which is the
midway point of your clavicle and you
will find the mitral valve also called
bicuspid valve and these are your a do
ventricular valves your AV valves and
this is also where you will hear the
point of maximal impulse and also it's
important to know the bottom part of the
heart down in this area is that apex the
top part of this area is called the base
you'll want to remember that now let's
look and auscultate these areas and see
what they look like on a real person
okay first I want to start out just
showing you on the chest what is where
you're going to actually place your
chest piece whenever you're listening to
the heart what I like to do whenever I'm
first starting out either have the
patient set up or lie down and I like to
start and they or tick and work my way
down remember the mnemonic all patients
take medicine and herbs point is in
between the pulmonic and the tricuspid
and whenever your semilunar valves are
your aortic and pulmonic and when they
close you hear s2 and so you're going to
hear s2 the most at the base of the
heart and then whenever you're hearing
the tricuspid and mitral which are your
ventricular valves which are AV
valves you're hearing s1 whenever they
close so let's use a chest piece and
auscultate okay whenever I'm beginning
auscultation of the heart what I like to
do is remove the clothing and
like to have the patient set up you can
also have them lay down and I listen
with a diaphragm of my stethoscope first
and then I'll switch to the bell and
redo all the anatomical sites but I like
to listen a diaphragm because you can
hear s2 and s1 the best with this along
with your aortic and pulmonic
regurgitation murmurs so I start at
theoretic remember the mnemonic all
patients take medicine and what I'm
going to do is I'm listening for s1 and
s2 I'm distinguishing them and I'm also
listening for s1 splits or s2 splits and
this is just where the valves are not
closing at the same time so you may hear
a little bit of an extra noise so we're
going to store in the aortic over here
and what I'm hearing is love dub lub dub
and dub is louder because dub represents
s2 and in the base of the heart you're
going to hear s2 louder then how you
would hear it down there then I'm just
going to inch over here to the pulmonic
and I hear the same thing I don't know
in any splitting s1 s2 or closing at the
same time no extra heart sounds then I'm
going to inch down to herbs point this
is just the halfway point between the
base and the apex of the heart now I'm
going to inch down to the tricuspid and
this time I'm hearing lub dub and love
is louder because this is signifying
more where you're going to hear s1 and
love is represented by s1 and I hear
that louder in this area and then I'm
going to go over to the mitral area mid
clavicular and this hearing the same
thing loved a nice good rhythm and what
I want to do is I'm just going to switch
over to my Bell and I'm just going to
repeat and what I'm really paying
attention to is I'm listening for any
type of murmurs or those low pitched
sounds you really can't hear s3 and s4
that great in this position that's why I
hear in a second we're going to get on
our left
and you hear that best in the apex but
what I'm listening for is maybe any
murmurs blowing swishing noise and I'm
not hearing anything
now one thing you may find hard whenever
you are auscultate is the sink wishing
s1 from s2 and some tips to help you
with that
again s2 is going to be louder here at
the base and s1 is going to be louder
here at the apex so that can help you
with that or if you're still having
trouble you don't can't really
differentiate and you can feel on the
carotid artery and listen at the apex of
the heart and whenever you feel a
pulsation and you feel you hear that
noise you've identified s1 because the
carotid pulse ation and the sound
signify s1 or if you have a patient on a
bedside monitor you can look at your QRS
complex in the AR way the big spike
whenever you see that spike and you hear
the noise that is s1 so those are just
some little tips on how you can
differentiate between s1 and s2
now we've assist the patient onto their
left side and the whole purpose of doing
this is majority of your heart is on
your left side so whenever you turn them
have them go there it pushes the heart
over a little bit more just so you can
hear those anatomical sites a little bit
better and what we are interested in is
the apex of the heart and we're going to
be listening with the bell of our
stethoscope because we're listening for
low pitched noises and if the patient
was going to have an s3 s4 or a module
stenosis murmur this is where we have
most likely hear it so what we're going
to do is just find the midclavicular the
fifth intercostal space we're going to
just listen over there and we're
listening for s3 or s4 and murmurs
and s3 is hurt after s2 so again that's
why you have to distinguish between s1
and s2 and s3 is going to sound like a
love dub to love data because it's heard
after s2 s4 is going to be heard before
s1 and it's going to sound like this
Tull of de mm de Tunnel lubed up and a
murmur of course is just that blowing
swishing noise okay last what I like to
do is I like to have the patient set up
and lean forward and then have them
exhale and I'm going to listen for what
I'm looking for is murmurs aortic and
pulmonic murmurs and want to be
listening at the aortic and the pulmonic
sides with the diaphragm because it's
good at picking up those murmurs and
what's happening is that the chest the
heart behind the storm is just moving a
little bit forward so we can hear those
anatomical positions a little bit better
and I'm listening for like a blowing a
swishing noise and if one's present
you'll want to grade that and here on
your screen you'll see what the grading
scale is for that one a grade one is
hard to hear and it goes all the way up
to six and this is the loudest you could
literally lift your chest piece off the
patient's chest like this and you could
hear just the blowing and swishing noise
you could also fill in the chest a
thrill which is like a vibration on the
skin okay so that is how you auscultate
heart sounds now be sure to check out my
other video where I go in-depth about
these heart sounds I talk in great
detail about them a card should be
popping up so you can access that video
so you can familiarize yourself with
these heart sounds thank you so much for
watching and please consider subscribing
to this YouTube channel
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