E-LessonEDAE 637

Lynn Senette

Auscultation of Heart Sounds for Beginners

orWhy does my care provider listen in so many

places?

Learning objectivesStudent will identify equipment needed

perform skillStudent will identify anatomical landmarks Student will demonstrate correct positioning

of clientStudent will differentiate which frequency of

sounds are heard best by the diaphragm and bell of the stethoscope

Student will demonstrate correct sequencing of auscultation

Student will utilize online resources for sound demonstrations

Heart Sounds for beginners Click here to hear normal heart sounds

Source: http://depts.washington.edu/physdx/heart/demo.html

Click here for an animation of heart contraction and blood flowSource: http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_pumping.html

Heart sounds are the noises produced by the beating heart from the flow of blood throughout it.Healthy adults: 2 normal sounds

Lub (aka S1): represents closure of the mitral and tricuspid valve and marks the beginning of systole (contraction)

Dub (aka S2): aortic and pulmonary valve closure at the beginning of diastole (rest/refilling)

Murmurs: often described as whooshing sounds resulting from turbulent flow. Can be benign or pathological. Murmurs may be due to:

Regurgitation: occurs when a valve doesn’t close properly and blood flows backward through it.

Stenosis: refers to the abnormal narrowing of the valve

Stethoscope

--Earpieces

--ear tubes

Tubing------

Diaphragm—for high Pitched sounds

Bell for low pitched sounds↓

Anatomical Landmarks Minimally 4 areas shouldbe auscultated using first the diaphragm,

then bellHelpful pneumonic:A Poor Tired Monkey Aortic region (between the 2nd and

3rd intercostal spaces at the right sternal border) (RUSB – right upper sternal border).

Pulmonic region (between the 2nd and 3rd intercostal spaces at the left sternal border) (LUSB – left upper sternal border).

Tricuspid region (between the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border) (LLSB – left lower sternal border).

Mitral region (near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line) (apex of the heart).

Source: 3M™ Littmann® Stethoscopes http://solutions.3m.com/wps/portal/3M/en_US/Littmann/stethoscope/education/tech-auscultation/

aortic stenosis This is what you might hear if you place the stethescope in the aortic area

pulmonic stenosis This sound might be present in a child with congenital heart disease

tricuspid region Here is an example of a benign murmur

mitral regurgitation This sound results from backward leaking of blood from the left ventricle to the left atrium.

Positioning the clientThe examiner should

be on the right (decreases extraneous noise)

Start with patient supine

The turn to the leftNext sit upFinally, lean forward

and hold breath

Source: 3M™ Littmann® Stethoscopes http://solutions.3m.com/wps/portal/3M/en_US/Littmann/stethoscope/education/tech-auscultation/

Get in the FlowSource: Labus, D. Heart sounds made incredibly easy. Philadelphia: Lippincott Williams & Wilkins.

Training Your Ears

There you have it—the basics to get started listening to heart tones. Grab your stethoscope and all of your friends and family. Find a quiet place and get started. Remember, healthcare is both an art and science. The art comes from years of practice in distinguishing the variations in heart tones.

Here are some very helpful sites you can visit to hear a myriad of heart sounds--- just imagine you have a waiting room full of clients- each with a unique ausculatory signature.

http://depts.washington.edu/physdx/heart/demo.html http://www.texasheart.org/education/cme/explore/events/

eventdetail_5469.cfm

 

ReferencesLabus, D. Heart sounds made incredibly easy. (2004).

Philadelphia:Lippincott Williams & Wilkins.

3M™ Littmann® Stethoscopes (2009). Retrieved April 1, 2009 from http://solutions.3m.com/wps/portal/3M/en_US/Littmann/stethoscope/education/tech-auscultation/

Texas Heart Institute (2009). Podcast: Heart Sounds. Retrieved on March 27, 2009

fromhttp://www.texasheart.org/education/cme/explore/events/eventdetail_5469.cfm

University of Washington. Heart sounds and murmurs exam. Retrieved on March 31, 2009 http://depts.washington.edu/physdx/heart/demo.html

U. S. Department of Health & Human Services National Institute of Health (2009). Heart

contraction and blood flow. Retrieved on March 30, 2009 from http://www.nhlbi.nih.gov/health/dci/Diseases/hhw/hhw_pumping.html