Practical 3 - Cardiac Auscultation

Question 1

What is cardiac auscultation?

Answer 1

Cardiac auscultation is an essential clinical skill and an integral part of
clinical medicine.
Auscultation of the heart is non-invasive and can be used to detect:
➢ Heart rate
➢ Heart rhythm
➢ Abnormalities (Murmurs, dysrhythmias)

Question 2

There are FOUR main regions of interest for auscultation. Where are they?

Answer 2

There are FOUR main regions of interest for auscultation.
1. Aortic region: 2nd intercostal space at the right sternal border.
2. Pulmonic region: 2nd intercostal space at the left sternal border.
3. Tricuspid region: at the 4th intercostal space at the left sternal border.
4. Mitral region: between the 5th and 6th intercostal spaces in the mid-clavicular line) (apex of the heart).

Question 3

What is S1 and S2 heart sounds?

Answer 3

The sounds heard via cardiac auscultation are the
sound of the valve cusps closing.
The first heart sound (S1) is when the tricuspid and
mitral valves close at the beginning of systole.
The second heart sound (S2) is when the aortic and
pulmonary valves close at the end of systole.

Question 4

What is irregular heart rhythm known as?

Answer 4

arrhythmia

Question 5

How is heart rhythm typically assessed?

Answer 5

Heart rhythm is typically assessed using an electrocardiogram (ECG)
but can be examined using auscultation.
Heart rhythm is the pattern in which the heart beats.

Question 6

How can we improve audio quality to cardiac auscultation?

Answer 6

➢ Ask the patient to lean forward and to the left
➢ Ask the patient to hold an expiration

Question 7

How do you perform cardiac auscultation?

Answer 7

Procedure
1. Ensure equipment is sanitised and then introduce yourself.
2. Explain what you will be doing (gain verbal consent).
3. Ask your partner to remove their upper body clothing (dignity)
4. Perform auscultation on all 4 regions with the diaphragm and bell.
5. Assess rate (bpm), rhythm and any abnormalities at each.

1. Aortic region: between the 2nd intercostal space at the right sternal border.
2. Pulmonic region: between the 2nd intercostal space at the left sternal border.
3. Tricuspid region: at the 4th intercostal space at the left sternal border.
4. Mitral region: between the 5th intercostal space in the mid-clavicular line (apex of the heart).

Question 8

What is S3 sound?

Answer 8

If venous return is high, the ventricles fill up quicker
causing the fluid to “bounce” of the walls of the heart. This
vibration can create a third sound (S3).
➢ S3 may sound like “lub-dub-ta)
➢ Common in pregnant women and athletes

Question 9

What is S4 sound?

Answer 9

In the event the ventricles become stiff (LV hypertrophy),
the atria need to contract more to squeeze blood into the
ventricles. This can create a fourth sound (S4)
➢ S4 may sound like “ta-lub-dub”

Question 10

What is a heart murmur?

Answer 10

A heart murmur is the result of turbulent flow through the
heart (whooshing, swishing, humming, or rasping sound)
Turbulent blood flow can be caused by:
➢ Stenosis = restricts blood flow (blockage)
➢ Regurgitation = blood flows backward (leaking)

Murmurs can be classified as:
➢ Systolic murmurs = occur during systole
➢ Diastolic murmurs = occur during diastole

Question 11

What are murmurs classified as?

Answer 11

Murmurs can be classified as:
➢ Systolic murmurs = occur during systole
➢ Diastolic murmurs = occur during diastole