1. CARDIAC AUSCULTATION

2. STATION LEARNING OBJECTIVES
Understand and describe the correct use of the stethoscope.
Describe the normal (1st & 2nd) heart sounds.
Describe and accurately demonstrate the four auscultatory areas.
Understand the timing of systolic and diastolic murmurs and recognise the difference between a pansystolic and an ejection systolic murmur and the conditions with which they are associated.

3. The STETHOSCOPE The BELL: amplifies low pitched sounds
The DIAPHRAGM: intensifies high-pitched sounds and normal heart sounds

4. AUSCULTATION AREAS Mitral area 4th ICS L Tricuspid area 5th ICS L
Pulmonary 2nd ICS L
Aortic 2nd ICS L

5. What do you need to consider during auscultation ?
the nature and intensity of the 1st and 2nd heart sounds
extra heart sounds (3rd & 4th)
any additional sounds such as snaps
murmurs
pericardial rub

6. MURMURS Timing - ?systolic ?diastolic Area of greatest intensity
Loudness & pitch
Dynamic manoeuvres

7. TIMING SYSTOLIC: pansystolic eg. mitral regurgitation
ejection systolic eg. aortic stenosis
DIASTOLIC: early diastolic
mid-diastolic eg. mitral stenosis
Continuous: heard throughout systole & diastole
Pericardial friction rub: scratching sound due to inflamed pericardial surfaces rubbing against each other
pericarditis
louder on sitting up & expiration

8. Dynamic Manoeuvres Respiration
Right sided murmurs are exaggerated on inspiration (increased venous return therefore increased blood flow to the right side of the heart)
Left sided murmurs are exaggerated on expiration
Valsalva - forceful expiration against a closed glottis
Mitral regurgitation and Aortic Stenosis become softer
Mitral valve prolapse & HOCM become louder
Exercise
Mitral stenosis murmurs are enhanced with exercise
Position
Left lateral: murmur of mitral stenosis exaggerated
Leaning forward: murmur of aortic regurgitation exaggerated

9. PANSYSTOLIC MURMUR OF MITRAL REGURG.
Acknowledgements: Macleod’s Clinical Examination, 10th Ed, pg 96
Click here to listen to an example of a pansystolic murmur

10. EJECTION SYSTOLIC MURMUR OF Aortic Stenosis
Acknowledgements: Macleod’s Clinical Examination, 10th Ed, pg 96
Click to hear a murmur associated with AS