Auscultation of the heart

1
Auscultation of the heart

2
Auscultatory content

• Heart rate
• Cardiac rhythm
• Cardiac sound
• extra cardiac sound
• Cardiac murmur
• Pericardial friction sound

3
Auscultatory valve

• Mitral valve area
• (Apical )
• Pulmonary
• Aortic
• The second aortic
• Tricuspid

4
Cardiac Sound

• Variations in heart sound
• Intensity Quality Splitting
• s1 ? MS P-R ? Contractility ?
  
• ? MI P-R ? Contractility ?
  AVB
• A2 ? hypertension
• ? AS AI
• P2 ? MS ASD VSD PDA
• ? PS PI

• Normal heart sound
• First heart sound (S1)
• Second heart sound (S2)
• Third heart sound (S3)
• Fourth heart sound (S4)

5

• expiration
  inspiration
• S1 A2 P2
  S1 A2 P2
• Physiological
• General
  
  
• P2 A2
  S2
• Reversed
• Fixed

6

• Extra cardiac sound
• Diastolic
• gallop rhythm
• protodiastolic (ventricular ) S3
• late diastolic (presystolic , atrial )
  S4
• summation
• Openning snap (os)
• Pericardial knock
• Tumor plop
• Systolic
• Ejection sound early systolic ----aortic ,
  pulmonary
• Click middle and late systolic click ----mitral
  valve prolapse
• 
  

7
Murmurs(1)

• Mechanism
• Luminar flow ? turbulent flow ?vortices ?
  murmur
• blood flow acceleration
  
• stenostic area
• incefitic area
• abnormal tract
• abnormal stucture
• aneurythm

8
Murmurs(2)

• Skills of auscultation
• Location
• Phase
• Character
• Radiation
• Intensity
• Relation with position, respiration, exercise

9
Murmurs

• Grade 1audible with special effort
• Grade 2faint but recognizable
• Grade 3moderate intensity
• Grade 4loud (commonly accompanied by a thrill)
• Grade 5louder,but still needing a
• stethoscope
• Grade 6audible with the stethoscope removed
  from
• contact with the chest

10
Murmurs(4)

• Clinic significance
• Systolic apical aortic
  pulmonary tricuspid
• Functional
• Physical
  ?
• Relatively LV ?( DCM ) ?
  ?
• Innocent ?
• Organic MI MVP AS
  PS
• Diastolic
• Organic MS AI
  
• Relatively Austin Flint
  Graham Steel
• Continuous
• Gibson murmur PDA

11
summary

• Cardiac sound
• extra cardiac sound
• D gallop OS( ms)
• S EC click
• Cardiac murmur
• S
• MI gt3/6, holosystolic , ?axilla
• AS cresendo-desendo, loud, ?neck
• D
• MS mid-late, rumbling
• AI early, high-pitched sigh