Auscultation
Protocols
1. mitral area : left 5th intercostal space just medial to mid calvicular line .
2. Tricuspid area: Left 4th interscostal space just lateral to the sternum .
3. Aortic area : Right 2nd interscostal space just lateral to the sternum .
4. Pulmonary area : left 2nd interscostal space just lateral to sternum.
- Heart Sound : -
1. 1st heart sound :
- a. procedure : Produced during ventricular systole due to closer of mitral and to a lesser extent of tricuspid valve .
- b. Best heard at the apex .
- c. Coincide with carotid pulse .
- soft 1st heart sound - Mitral regurgitation
- Louder 1st heart sound - Mitral stenosis.
2. 2nd Heart Sound :
- a. produced during ventricular diastole due to closure of aortic and pulmonary valve.
- b. Best heard at the base of heart ( aortic area & pulmonary area )
- component A2 & P2(pulmonary HTN) .
3. 3rd Heart sound :
- a. physiological :
- -healthy young adults
- - athletes
- -pregnancy
- - fever
- b. Pathological :
- -large, poorly conracting left vetricle .
- - mitral reflux
4. 4th Heart sound :
- systemic hypertension
- Hypertophic cardiomyopathy
- Aortic stenosis
- ischaemic heart diseases
Comment: 1st & 2nd heart sound is auideble in all area & normal
1. intensity of heart sound:
1st Heart sound ::
- a. soft :- mitral regurgitation ,low cardiac out put
- b. Loud :- increase cardiac out put ,mitral stenosis ,atria myxoma
- c. variable :- Arial fibrilation ,Extrasystole ,Complete heart block .
2nd Heart sound intensity:-
- a.Soft : aortic stenosis ,pulmonary regurgitation.
- b. Loud : systemic hypertension ,pulmonary HTN.
2. Splitting:-
- a. Fixed splitting : when splitting found both expiration & inspiration .
- b.wide & fixed splitting:
- c: Rverse splitting
3. Gallop Rhythm :
- Gallop rhythm is fast tripple rhythm which is a feature of Heart failure .