VIDEO ANNOTATION

CARDIO AUSCULTATION
To optimize the effectiveness of auscultation, the surroundings should be quiet, warm, and with
appropriate lighting.
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First we have to remove our patient’s upper garment.
Next, we have to warm our stethoscope using our hands.
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The diaphragm of the stethoscope is placed firmly on the chest wall to auscultate for high
pitched sounds.

The bell is placed lightly on the chest wall to detect low pitched-sounds
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To begin auscultating, we have to locate the bony landmark, the Sternal Angle of Louie. The
Angle of Louis is contiguous with the 2nd rib.

The 2nd right ICS is the landmark for the aortic valve. Just across, is the pulmonary valve
located at the left 2nd ICS parasternal line. Below it is the tricuspid, located at the 3rd left ICS
parasternal line. Located at the point of maximal impulse, is the mitral valve, which, for children
less than 7 years old is located at the 4th left ICS midclavicular line.

While doing so, the examiner should characterize the individual heart sounds and their
variations with respiration. The first heart sound is caused by the closure of the AV valves and is
best heard at the apex. The second heart sound is caused by closure of the semilunar valves
and is best heard at the upper left and right sternal borders.

Normally S2 is split during inspiration and less so in expiration.

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In auscultating for murmurs, one should describe them according to their intensity, pitch, timing
(systolic or diastolic), variation in intensity with respiration, time to peak intensity, areas of
maximal intensity, and radiation to other areas. We also have to auscultate across the upper
precordium, down to the left or right sternal border, out to the apex, and both the axillas and
also over the back

A third heart sound may be heard at the apex in mid-diastole. This is best done using the bell.
An S3 is heard as a gallop rhythm in the setting of heart failure due to poor compliance of the
ventricle, but may be normal in a young patient with tachycardia.
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We may repeat the same procedures, this time the patient lying supine.