hi let's talk about cardiac auscultation in this video we'll discuss the typical
auscultation points for the heart valves auscultation means to listen so as we recall
the bulk of the heart about two-thirds of it will rest left of midline about one-third
to the right of midline and if we look at the sternocostal projections of these heart valves
we see that frequently they are behind osseous tissue or behind bone now being behind bone is
going to make direct auscultation of these valves very difficult but what we can do
is we can follow the trajectories of blood to the nearest point where these pathways are not
obscured by bone and we can auscultate there so for instance let's start with the aortic valve
the aortic valve is delivering that blood through the ascending aorta and it's transitioning into
the aortic arch going that way but before it does so sound is going to be conducted in the
direction of that blood to this location that's going to be the right second intercostal space
just to the right of the sternum now the second intercostal space is the space beneath the second
rib that second rib is going to articulate with the sternum at the sternal angle so if
you can palpate the sternal angle or even see the sternal angle you can immediately locate
that second intercostal space and go immediately to the right of the sternum
to auscultate the pulmonary valve the pulmonary valve is sending blood out the pulmonary trunk
to the arteries that's going to also be in the second intercostal space this time to
the left of the sternum and so that is where we would place the bell of the stethoscope
in order to auscultate the pulmonary valve in order to auscultate the tricuspid valve this is
a little more tricky we would put the bell of the stethoscope in the left either fourth or
fifth intercostal space sometimes also below the costal margin here on the left so this is the most
variable of all of the locations for auscultating the tricuspid valve but you would start in the
fourth or fifth intercostal space and and move the the bell around in order to auscultate the
bicuspid valve we would go in the fifth intercostal space almost in the midclavicular line
so just to the right of the midclavicular line to put the bell of the stethoscope and that would
correspond to approximately the apex of the heart so that would be for the bicuspid valve
now there are various mnemonics that you might learn in doctoring so aortic pulmonary
tricuspid bicuspid oftentimes this is presented as apartment b
so we've discussed the um the reasons why uh cardiac valves cannot be auscultated directly
rather why you need to follow the path of blood flow to the nearest unobstructed by osseous
tissue region of the thorax and the particular locations of auscultating the aortic pulmonary
tricuspid and bicuspid valves this is your summary slide thank you very much for your time