1. Areas of Auscultation Chapter 5 Ara G. Tilkian, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS

2. Outline Traditional Areas of Auscultation Left Ventricular Area Right Ventricular Area Left Atrial Area Right Atrial Area Aorta Area Pulmonic Area

3. Traditional Areas of Auscultation Mitral Area –Cardiac Apex Tricuspid Area-4 th & 5 th intercostal space of left sternal border Aortic Area-2 nd intercostal space of the right sternal border Pulmonic Area-2 nd intercostal space left sternal border

5. Left Ventricular Area Aortic component of the 2 nd heart sound A 2 Cardiac Apex and extends laterally in the 3rd and 4th interspaces to left sternal border in one direction & to the anterior axillary line in the other.

6. Right Ventricular Area Tricuspid Stenosis or regurgitation, pulmonary regurgitation and ventricular septal defect.

7. Left Atrial Area Mitral Regurgitation Anterior chest-listen left of apex Posterior left thorax- area between the spine and the border of the scapula at the level of its tip

8. Right Atrial Area Tricuspid insufficiency is best heard at the right sternal border in the 4 th and 5 th interspaces.

9. Aortic Area Aortic Ejection Click and A 2 Aortic stenosis & Insufficiency Increased aortic flow Dilatation on the ascending aorta Abnormalities of the carotid or subclavian arteries

10. Pulmonic Area Pulmonic Ejection & P 2 Pulmonary Stenosis & insufficiency Increased pulmonary flow & stenosis Patent Ductus arteriosus PDA

11. THE END OF CHAPTER 5 Tilkian, Ara MD Understanding Heart Sounds and Murmurs, Fourth Edition, W.B. Sunders Company. 2002, pp. 43-48.