Corpus: Cardiac auscultation

Cardiac auscultation is a part of the physical examination. It is used to assess normal heart sounds and detect abnormal heart murmurs, which may indicate conditions such as heart valve disease.

Cardiac auscultation is performed using a stethoscope. Typically, only two of the four heart sounds can be heard in a normal examination.

The examination can be conducted with the patient standing, sitting, or lying down. However, for better sound clarity, it is recommended to perform the auscultation while the patient is seated.

Auscultation is performed at five standard anatomical points on the chest, where heart valve sounds are best heard:

• 2nd intercostal space, right of the sternum – aortic valve
• 2nd intercostal space, left of the sternum – pulmonary valve
• 3rd intercostal space, left of the sternum – Erb’s point
• 4th intercostal space, left of the sternum – tricuspid valve
• 5th intercostal space, left midclavicular line – mitral valve

The examination usually starts at the base of the heart (aortic and pulmonary valves) and proceeds downward toward the apex. Alternatively, auscultation can be performed in pairs—first both upper points (aortic and pulmonary), then both lower points (tricuspid and mitral), beginning on the right side and then moving to the left.

If breath sounds interfere with auscultation, the patient can be asked to briefly hold their breath. It is also helpful to simultaneously palpate the radial artery pulse to detect a possible pulse deficit (a difference between the heart rate and pulse rate), which may occur in conditions such as arrhythmia, heart failure, or vascular narrowing. Additionally, this allows for the accurate distinction between systolic and diastolic murmurs.

A well-known mnemonic for the auscultation points of the heart is:

• "APE To Man"

The bold letters of the words stand for the respective heart valves and points.

• Aortic valve
• Pulmonary valve
• Erb's point
• Tricupsid valve
• Mitral valve