Auscultation of lungs and heart
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The document provides an overview of auscultation techniques for lung and heart examination using a stethoscope. It details the anatomy of lungs, common lung sounds and their identification, as well as heart sounds and their auscultation points. The document also describes adventitious sounds, heart murmurs, and basic principles for performing these assessments effectively.
Auscultation of lungs and heart
- 1. AUSCULTATION LUNGS & HEART Anil Patidar MTIN, CHARUSAT
- 2. • Auscultation is the act of listening to sounds made by internal organs and vessels of the human body. • This is usually done with a device called a stethoscope. • It is a technique used to examine the respiratory system (breath sounds), cardiovascular system (heart sounds and vascular bruits) and gastrointestinal system (bowel sounds).
- 3. Anatomy of Lungs • The right lung is divided into 3 main lobes which are separated by the These lobes are: the superior, middle and inferior lobes. The left lung is separated by the oblique fissure into 2 main lobes: the superior and inferior.
- 4. Auscultation points Auscultate point Location APEX of the lungs bilaterally 2cm superior to medial 1/3 of clavicle Superior Lobes anterior 2nd intercostal space mid clavicular line Superior Lobes posterior Between C7 & T3 Middle lobe right anterior only 4th intercostal space mid- clavicular line Inferior Lobes bilaterally anterior 6th intercostal space, mid- axillary line Inferior Lobes bilaterally posteriorly between T3 & T10
- 5. Identification of Inter Costal Space From the angle of Louis, move your fingers to the right and you will feel a gap between the ribs. This gap is the 2nd Intercostal space
- 6. How to Auscultate Lung Sounds Listen to both the anterior and posterior sides of the chest Start at the top and work your way to the bottom of the chest while comparing sides When listening note the following: A full inspiration and expiration cycle The inspiration and expiration sound’s pitch, quality, duration, and if it is normal sounding is there anything “weird” heard along with the inspiration and expiration.
- 7. Have the patient sitting up with arms resting on lap. When listening to the posterior side of the chest the arms need to definitely be in the lap so the scapulae are separated. Use the diaphragm of the stethoscope to auscultate at various locations Have patient breathe in and out through mouth slowly while listening. Allow the patient to set the pace to prevent hyperventilating , especially patients with breathing disorders like COPD.
- 8. Anterior Lung Auscultation Points Start at: the apex of the lung which is right above the clavicle 2nd intercostal space to assess the right and left upper lobes. 4th intercostal space you will be assessing the right middle lobe and the left upper lobe midaxillary at the 6th intercostal space you will be assessing the right and left lower lobes.
- 9. Posterior Lung Auscultation Points Start right above the scapulae to listen to the apex of the lungs. Then find C7 (which is the vertebral prominence) and go to T3…in between the shoulder blades and spine. This will assess the right and left upper lobes. Then from T3 to T10 you will be able to assess the right and left lower lobes.
- 10. Normal Breath Sounds • Bronchial • Bronchovesicular • Vesicular • Tracheal
- 11. Name of sound Duration of sound Intensity of Expiratory sound Pitch of expiratory sound Location where heard normally Bronchial inspiration will be slightly SHORTER than expiration Loud Relatively high Over on manubrium (Larger Proximal airway) Broncho vesicular: inspiration and expiration will be EQUAL Intermediate Intermediate anteriorly: 1st and 2nd intercostal space near the sternum posteriorly: between the scapulae Vesicular: inspiration will be slightly GREATER than expiration Soft Relatively Low auscultated anteriorly and posteriorly and heard over peripheral lung fields Tracheal Inspiration and expiration will be about to Equal Very Loud Relatively high Over the trachea in the neck
- 12. Adventitious Sounds A) Discontinuous Lung Sounds: • These are extra sounds heard LESS than 0.2 seconds during a full respiration cycle. Coarse Crackles: Crackles are also known as: rales •Auscultated during inspiration and can extend into expiration as well •Low-pitched, wet bubbling sound •May be heard in patient with Coarse Crackles: Crackles are also known as: rales •Auscultated during inspiration and can extend into expiration as well •Low-pitched, wet bubbling sound •May be heard in patient with fluid overload, pneumonia etc. Pleural Friction Rub: •Auscultated during inspiration and expiration •Low-pitched/harsh grating sound •Patients may have pain when breathing in and out due to inflammation of pleural layers •May be heard in patients
- 13. • B) Continuous Lung Sounds: • These are extra sounds heard MORE than 0.2 second during a full respiration cycle High Pitched, Polyphonic Wheeze Also known as: Sibilant Wheeze •Auscultated mainly in expiration but may be present during inspiration •Sounds like a high-pitched musical instrument with MORE than one type of sound quality •May be heard in patients with asthma Low-pitched, Monophonic Wheeze Also known as: Sonorous Wheeze or Rhonchi •Auscultated mainly in expiration but may be present at anytime •Sounds like a low-pitched whistling tune or whine with ONE type of sound quality •May be heard in patients with COPD or pneumonia etc. Stridor •Auscultated during inspiration •high-pitched whistling or gasping sound with harsh sound quality •May be seen in children with conditions such as croup or epiglottitis or anyone with an airway obstruction etc.
- 14. Heart sound • Heart sounds are caused by the closure of heart valves. The first sound you hear is S1 and is caused by the closure of the atrioventricular valves (AV) TRICUSPID AND MITRAL VALVES. This sounds like “LUB”. S1 The second sound you hear is S2 and is caused by the closure of the semilunar valves (SL) AORTIC AND PULMONIC VALVES. This sounds like “DUB”. S2 S3 –associated with blood flowing into the ventricles S4 –associated with atrial contraction Four heart sounds can be recorded by phonocardiography, but normally only the first and the second heart sounds, are audible through a stethoscope
- 15. • Normally, the AV valves close at the same time and the same is true for the SL valves. However, in some people these valves may close asynchronously and this would cause a split in sound. • S1 split: Tricuspid and mitral valves closing asynchronously • S2 split: Aortic and pulmonic valves closing asynchronously
- 16. Heart Auscultation Sites Remember the mnemonic “All Patients Take Medicine”. This represents the order of auscultate the heart.
- 17. Aortic: found right of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub” Pulmonic: found left of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub” Erb’s Point: found left of the sternal border in the 3rd intercostal space Tricuspid: found left of the sternal border in the 4th intercostal space REPRESENTS S1 “lub” Mitral: found midclavicular in the 5th intercostal space REPRESENTS S1 “lub” (also the site of point of maximal impulse)
- 18. • The Base of the heart includes the aortic and pulmonic areas, and S2 will be loudest at the base. • Aortic and pulmonic murmurs are heard best at the base with the patient leaning forward and sitting up with the diaphragm of the stethoscope. The Apex of the heart includes the tricuspid and mitral areas, and S1 will be loudest at the apex. S3 and S4 along with mitral stenosis murmurs will be heard best at this position with the patient lying on their left side with the bell of the stethoscope.
- 19. Basics about S3 & S4 * S3 and S4 are heard best at the apex of the heart with the bell of the stethoscope while the patient is on their left side. S3: heard after S2 and sounds like “LUB-DUB-TA” • Caused by vibrations of ventricle filling from a resistant ventricle due to fluid volume overload or heart failure. S4: heard before S1 and sounds like “TA-LUB-DUB” • Caused by ventricle resistance from an atrial “kick” during presystole (hypertrophic left ventricle)
- 20. Heart Murmur • Cardiac murmurs are abnormal heart sounds in the form of noises resulting from turbulent blood flow, • Murmurs may be: • Systolic murmurs, if they occur during systole. • Diastolic murmurs, if they occur during diastole • Causes: • Stenosis (narrowing) of heart valves • Incompetence of heart valves • Increase of blood flow or decrease of blood viscosity (as in anemia).
- 21. Two Basic Types of Valvular Diseases Valvular stenosis: • narrowing of the valve valvular insufficiency (incompetence): • valve is unable to close fully; so there is regurgitation
- 22. Thank You