When listening for abnormalities, auscultate in these areas:
Aortic: right sternal, 2nd intercostal space
Pulmonic: left sternal, 2nd intercostal space
Tricuspid: left sternal, 4th intercostal space
Mitral: left midclavicular (near PMI), 5th intercostal space
2 things you should figure out:
1) Is it a R or L heart problem? R-sided heart sounds increase intensity with inspiration (you suck more blood into the right heart from the system, exacerbating heart sounds). L-heart sounds increase intensity with expiration.
2) Is it systolic or diastolic? Systolic is (as you well know) increased pressure in the ventricle due to ventricular contraction. Valvular defects that manifests: AV valves forced to close (Mitral/Tricuspid regurgitation audible), and blood must be pumped through aortic or pulmonic valves (Aortic/Pulmonic stenosis audible). Diastolic heart sounds are the opposite.
Also, did you know that the S1 and S2 heart sounds are not actually the sound of the valves closing, but the sound of turbulent blood flow hitting the valves AFTER they closes? I thought that was interesting.
2 things you should figure out:
1) Is it a R or L heart problem? R-sided heart sounds increase intensity with inspiration (you suck more blood into the right heart from the system, exacerbating heart sounds). L-heart sounds increase intensity with expiration.
2) Is it systolic or diastolic? Systolic is (as you well know) increased pressure in the ventricle due to ventricular contraction. Valvular defects that manifests: AV valves forced to close (Mitral/Tricuspid regurgitation audible), and blood must be pumped through aortic or pulmonic valves (Aortic/Pulmonic stenosis audible). Diastolic heart sounds are the opposite.
Also, did you know that the S1 and S2 heart sounds are not actually the sound of the valves closing, but the sound of turbulent blood flow hitting the valves AFTER they closes? I thought that was interesting.
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