Understandtheprinciplesofausculta2onandprac2ceitundersupervision.

Useastethoscope

GiveyourUCASformandmedicalschool

interviewsawinningedge

Workaspartofateamtodiscernnormalheartsounds

SWOT

Thisisthebell;itisnormallypressedlightlyagainstthepa2entandusedtopickuplowerfrequencysoundssuchasheartmurmursandbowelsounds. Thisisthediaphragm;

it’sthemostcommonlyusedpartofthestethoscope.ThediaphragmisgoodatpickinguphighfrequencysoundssuchasnormalbreathingsoundsandS1andS2heartsounds.

Youshouldholdthechestpiecebetweenthedistalpartofyourindexandmiddlefingers.Thisallowsagentletouchandpreventsrubbing,whichcausesaddi2onalnoise.

WhenthetwoventriclescontractbloodaJemptstoflowbackintotheatriums.ThiscausestheatrioventricularvalvestoslamshutwhichmakestheS1,or“lub”sound.

Astheventriclescontractthesemilunarvalvesopentoletbloodheadtoeitherthelungstobeoxygenatedortotherestofthebody.AstheventriclesrelaxbloodtriestoflowbackintothemcausingthesemilunarvalvestoslamshutwhichmakestheS2,or“dub”sound.

TheS3heartsound,alsoknownastheventriculargallop,iscausedwhentheleOventricleisoverlycompliant.Thisresultsinbloodoscilla2ngbetweenthewallsoftheventriclecausingthewallstoreverberateandproducetheextrasound.Thisisn’tconsideredabnormalinmanychildren,pregnantwomenandathletes.

TheS4heartsound,alsoknownasthepresystolicgallop,occursiftheleOventricleisnoncompliantwhentheleOatriumcontracts.ThiscausestensionintheleOventriclewhichproducestheS4sound.

Heartmurmursarewhentheflowofblooditselfthroughtheheartisaudible;thiscanbeharmless.Oneofthemostcommoncausesofabnormalheartmurmursisstenosis(thenarrowingofapassageway).

Aor2cstenosis

Mitralstenosis

Thisistheaor2clisteningpoint.HereitiseasytohearS2soundswithaswellasaor2cvalvemurmurssuchasthosecausedbyaor2cstenosis.

Thisisthepulmoniclisteningpoint.HereyoucanbesthearS1aswellasanyheartmurmurscausedbythepulmonaryvalve.

Thisisthetricuspidlisteningpoint.HereyoucanbesthearS1aswellasheartmurmurscausedbythetricuspidvalve.

Thisisthemitrallisteningpoint,whichmeansit’seasytohearS2soundsheretoo.Youcanalsoheartmurmursfromthemitralvalve,suchasthosecausedbymitralstenosisaswellasS3andS4soundswiththebell.

Themostcommonlyheardbreathingsoundsareknownasvesicularbreathsounds.Thesecanbeheardovermostofthelungssurfaces.

Bronchialbreathsoundsarealsoconsiderednormalbreathingsounds.Thesearehollow,tubularsoundsandcomefromthetrachea.

Cracklescanbeheardwhenthereisfluidinsmallairwaysinthelungs.Thesoundiscausedbythesmallairwaysandalveoli,thathavecollapsedduetotheliquid,“poppingopen”.

Wheezingcanbeheardwhenthereareobstruc2onswithintheairways.Thesmallerairwaysmeanairisforcedthroughthematgreaterspeeds,producingthewheezingsound.

Diagnosiscanbebrokendownintotwosteps:•  Thefirststepisanyac2vi2esundergoneinordertofindoutwhat’swrong.Ausculta2onfitsintothisstep.•  Thesecondstepisnamingthedisease.

Prognosisisthelikelyoutcomeofadiagnosis.It’spossiblefortwopa2entstohavethesamediagnosisbutdifferentprognosesduetofactorsunrelatedtothediagnosissuchasageandotherhealthfactors.Thereareessen2allythreedifferenttypesofprognosis:•  Thecondi2oncanbecuredandthepa2entislikelytolivetherestoftheirlife

unaffected.•  Thecondi2oncan’tbecured,howeveritismanageableandthepa2entis

likelytocon2nueliving.•  Thecondi2onisterminal.

LungsoundsThelungsandairwaysrequiredifferentlisteningskillsfromthoseusedtodetectheartsounds.Thestethoscopemustbeplacedoverthechest,andthepersonbeingexaminedmustbreatheinandoutdeeplyandslowly.Usingthebell,thelistenershouldnotedifferentsoundsinvariousareasofthechest.Then,thediaphragmshouldbeusedinthesameway.Therewillbenowheezesorcracklesinnormallungsounds.Cracklesorwheezesareabnormallungsounds.Whenthelungrubsagainstthechestwall,itcreatesfricEonandarubbingsound.Whenthereisfluidinthelungs,cracklesareheard.Ahigh-pitchedwhistlingsoundcalledawheezeisoIenheardwhentheairwaysareconstricted.

DiagnosisandaeEologyWhenlisteningtotheheart,onemustlistentotheleIsideofthechest,wheretheheartislocated.Specifically,theheartliesbetweenthefourthandsixthribs,almostdirectlybelowthebreast.Thestethoscopemustbemovedaround.AhealthcareprovidershouldlistenfordifferentsoundscomingfromdifferentlocaEons.Thebell(onesideofthehead)oftheinstrumentisgenerallyusedforlisteningtolow-pitchedsounds.Thediaphragm(theothersideofthehead)oftheinstrumentisusedtolistentodifferentareasoftheheart.Thesoundsfromeachareawillbedifferent.“lub-dub"isthesoundproducedbythenormalheartasitbeats.EveryEmethissoundisdetected,itmeansthattheheartiscontracEngonce.Thenoisesarecreatedwhentheheartvalvesclicktoclose.Whenonehears"lub,"theatrioventricularvalvesareclosing.The"dub"soundisproducedbythepulmonicandaorEcvalves.Otherheartsounds,suchasaquiet"whoosh,"areproducedby"murmurs."ThesesoundsareproducedwhenthereareirregulariEesinthepathofbloodflowthroughtheheart.Thesoundsreflectturbulenceinnormalbloodflow.Ifavalveremainsclosedratherthanopeningcompletely,turbulenceiscreatedandamurmurisproduced.Murmursarenotuncommon;manypeoplehavethemandareunaffected.Theyarefrequentlytoofainttobeheardandremainundetected.

hTps://www.youtube.com/watch?v=J8E6SrRhBSs

Quali2esofSoundQuality:ThisdisEnguishestwosoundsofsimilarfrequencyandintensity,eg.lungfromheartsounds.Dura2on:ThelengthofEmeasoundlasts.Forexample,normalS1andS2soundstendtobeshort,whilemurmursarelong.ThehumanearcanonlydisEnguishsounds>0.02secondsapart.NormalS1andS2soundsMurmur

Quali2esofSoundFrequency:Thenumberofwavesgeneratedpersecond.Intensity:TheloudnessorsoInessofsound.Thisisdeterminedbytheamplitudeofthewave.