A site for medical students - Practical,Theory,Osce Notes

Method of Cardiac Auscultation

Patient is asked to be in supine position or in propped up position if orthopnoea present. The conventional sequence of auscultation of areas - Mitral area - tricuspid area - pulmonary area - aortic area - second aortic area

One should start auscultating mitral area with bell, then with diaphragm of stethoscope. For better appreciation, patient can be put in left lateral position.

Mitral area
Search for abnormality of S1 and presence of S3, S4, Opening snap and mitral systolic and diastolic murmur, conduction of systolic murmur to axilla

Tricuspid area 
You should look for diastolic and systolic murmurs of tricuspid valve disease, augmentation with inspiration in the sitting position is noticed

Pulmonary area 
Identify the abnormality of S2, alteration in intensity and split, ejection click, systolic, diastolic and continuous murmur

Aortic area 
Ask the patient to be in the sitting posture ,leaning forward and breath held in expiration. Look for intensity of aortic component of S2, aortic, systolic and early diastolic murmur

Second aortic area 
Sometimes aortic events are better heard in the 2nd aortic area and the position of the patient is as above.