Auscultation Position For Aortic Regurgitation

Overview. Auscultation of heart sounds and murmurs is a rewarding and important skill of physical examination that leads directly to several clinical diagnoses. In this section, you will learn the techniques for identifying S1 and S2, extra sounds in systole and diastole, and systolic and diastolic murmurs. Review the auscultatory areas on the next page with the following caveats: (1) some authorities discourage use of these names since murmurs of more than one origin may occur in a given area; and (2) these areas may not apply patients with dextrocardia or anomalies of the great vessels. Also, if the eart is enlarged or displaced, your pattern of auscultation should be altered accordingly.

listen to the heart with your stethoscope in the right 2nd interspace close to ie sternum, along the left sternal border in each interspace from the 2nd irough the 5th, and at the apex. Recall that the upper margins of the heart are sometimes termed the "base" of the heart. Some clinicians begin auscultation at the apex, others at the base. Either pattern is satisfactory. The room should be quiet. You should also listen in any area where you detect an abnormality and in areas adjacent to murmurs to determine where they are loudest and where they radiate.

Auscultate Precordium

Know your stethoscope! It is important to understand the uses of both the diaphragm and the bell.

■ The diaphragm. The diaphragm is better for picking up the relatively high-pitched sounds of S1 and S2, the murmurs of aortic and mitral regurgitation, and pericardial friction rubs. Listen throughout the precordium with the diaphragm, pressing it firmly against the chest.

■ The bell. The bell is more sensitive to the low-pitched sounds of S3 and S4 and the murmur of mitral stenosis. Apply the bell lightly, with just enough pressure to produce an air seal with its full rim. Use the bell at the apex, then move medially along the lower sternal border. Resting the heel of your hand on the chest like a fulcrum may help you to maintain light pressure.

Pressing the bell firmly on the chest makes it function more like the diaphragm by stretching the underlying skin. Low-pitched sounds such as S3 and S4 may disappear with this technique—an observation that may help to identify them. In contrast, high-pitched sounds such as a midsystolic click, an ejection sound, or an opening snap, will persist or get louder.

Listen to the entire precordium with the patient supine. For new patients H and patients needing a complete cardiac examination, use two other im-^ portant positions to listen for mitral stenosis and aortic regurgitation.

■ Ask the patient to roll partly onto the left side into the left lateral decubitus ~ position, bringing the left ventricle close to the chest wall. Place the bell J of your stethoscope lightly on the apical impulse.

Heart sounds and murmurs that originate in the four valves are illustrated in the diagram below. Pulmonic sounds are usually heard best in the 2nd and 3rd left interspaces, but may extend further.

Heart Sound
(Redrawn from Leatham A: Introduction to the Examination of the Cardiovascular System, 2nd ed. Oxford, Oxford University Press, 1979)

This position accentuates or brings out a left-sided S3 and S4 and mitral murmurs, especially mitral stenosis. You may otherwise miss these important findings.

Auscultate Left Lateral

■ Ask the patient to sit up, lean forward, exhale completely, and stop breathing in expiration. Pressing the diaphragm of your stethoscope on the chest, listen along the left sternal border and at the apex, pausing periodically so the patient may breathe.

This position accentuates or brings out aortic murmurs. You may easily miss the soft diastolic murmur of aortic regurgitation unless you use this position.

Heart Murmur Auscultation LocationSit Lean Forward Exhale Auscultate
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Responses

  • HAMZA
    Where to listen for a pericardial friction rub?
    6 years ago
  • Carmine
    Where to auscultate for aortic stenosis?
    6 years ago
  • HARVEY
    Where to auscultate for aortic regurgitation?
    5 years ago
  • Battista
    Why should you use the lateral position for mitral stenosis?
    5 years ago
  • tiziano capon
    Where to listen for aortic regurgitation?
    4 years ago
  • Paavo
    What position is best to hear aortic regurgitation?
    4 years ago
  • furuta yemane
    What position is best to hear mitral stenosis?
    4 years ago
  • ONNI
    Where on chest to best hear aortic regurgitation?
    4 years ago
  • DEREK
    How to position the patient to listen for aortic regurgitation?
    4 years ago
  • FETHAWIT
    How to position a patient to jear an aortic murmu?
    4 years ago
  • camelia
    What is the best position to hear an aortic regurgitation murmur?
    4 years ago
  • giacinto capon
    What position accentuates a aortic regurgitation murmur?
    3 years ago
  • rahel
    What is the best position for a patient to listen to murmur?
    3 years ago
  • Olga
    What position is best to hear aortic stenosis?
    3 years ago
  • birgit
    Where to place stethoscope to hear s1 and s2?
    3 years ago
  • prima
    Where to auscaltate for aortic regurgitation?
    2 years ago
  • Daniel
    Where do you listen on chest for aoritc regurgitation?
    2 years ago
  • leo
    Where should you auscultate to hear aortic regurg?
    2 years ago
  • claudia
    When auscultating the heart for aortic insufficiency, ask the patient to:?
    2 years ago
  • penny
    Where is the precordium located?
    1 year ago
  • isotta
    Where to put the stethoscope on the chest s1 s2 s3 s4?
    1 year ago
  • marmaduke
    Where can you auscultate cardiac tones to hear a systolic murmur related to aortic regurgitation?
    11 months ago
  • fiori
    Where to listen to aortic stenosis?
    11 months ago
  • raymond lapan
    Where place diaphragm of stethoscope places to aortic area in chest?
    11 months ago
  • MOSCO DIGGLE
    How to assess for aortic inssuficciency position?
    5 months ago
  • denise
    What position do you assume when trying to listen for a diastolic murmur?
    4 months ago
  • Goldilocks Hornblower
    Which positions can aortic stenosis be heard?
    4 months ago
  • nicol
    Where to listen for aortic murmur?
    4 months ago
  • Benjamin Austerlitz
    Where to place stethoscope for aortic sounds?
    3 months ago
  • tolman
    Can you hear aortic regurg with diaphragm or bell?
    3 months ago
  • David
    How to position patient to hear murmur of aortic insufficiency?
    3 months ago
  • logan
    How to comment on aortic regurge murmur?
    2 months ago
  • alyx
    How to listen for arotic insufficieny?
    2 months ago
  • elen gabriel
    Where to position the stethoscope for murmur?
    9 days ago

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