hi there my name is Nico and this is Michael and we're medical students at the University
of Michigan in this video we'll be discussing and demonstrating a cardiac auscultation cardiac
auscultation is a really useful tool for getting a general picture of your patients heart health
to do the auscultation we'll use a stethoscope this is a tool that you see a lot of times with
health care professionals that help us listen to the sounds of the body like the heart lungs and
the GI when you listen to the heart there are some sounds that you focus on the healthy heart sounds
are the s-1 and s2 or the lub dub that dr. Fox mentioned in the videos earlier there are some
other heart sounds that we want to pay attention to that should be absent in normal patients but we
want to detect in case anything's wrong these will be sounds like murmurs or clicks there are others
named s3 and s4 so before doing the demonstration I wanted to introduce a mnemonic that we use to
find the different valves of the heart and that is apartment M so that's going to be ap TM and you
order pulmonary tricuspid and mitral so to get the demonstrated started I'm gonna have Michael remove
his shirt and then we'll begin looking for the valves so as you'll recall from the lesson your
heart kind of sits in your anterior chest but more on the left side and the valves have a certain
anatomical location however when we auscultate we're not actually going to be listening to the
anatomical locations of the valves but rather where the sound travels to in the chest cavity
so as I mentioned the mnemonic we use is a PTM so we're going to start with the aortic valve so
the aortic valve is going to be in the second intercostal space on the right sternal border
so that's going to be right around here and the way that I know that is I look for the sternal or
jugular notch on the sternum which is at the top of the manubrium and I travel down to what is the
sternal angle the sternal angle is where the body of the stern and the manubrium of the sternum meat
so I add the sternal angle I move immediately to the patient's right side so it's the left
in the video and that is where I'll be able to auscultate the aortic pulse or the Artic valve
sound so the Aortic valve as you know closes at the end of systole and that's going to make so as a
result the s2 is going to be stronger so you're gonna hear more of a dub lub dub so that's that
the aortic valve the pulmonary valve is going to be at the same height but on the opposite side so
now we're on the left the patient left second intercostal sternal border and so once again
I look for the jugular notch and I travel down to the sternal angle and it's gonna be immediate I'm
immediately on the left so once again that's an s2 heavy heart sound and it's gonna be look dub
lip dub now I'm gonna look for the tricuspid valve and so I always remember tricuspid is tricuspid so
it's the right AV valve but you're gonna listen to it on the left side of the chest so here's
my sternal angle okay and here's the pulmonary the tricuspid valve is gonna be at the fourth or
fifth intercostal so just about a few inches below that right around here okay and if I were to put
these in I would obstacle tape right around here okay and so again this the tricuspid valve is an
AV valve so it's going to be s1 heavy or lub-dub lub-dub so that's kind of subtle up here we said
it's a dub dub here it's lub dub so that takes some practice to distinguish but if you end up in
a clinical setting you'll be able to sit down to detect it so once again here we found our
tricuspid valve at the fourth or fifth intercostal space on the left sternal border and now the final
one is the mitral valve or the bicuspid of the left or the left AV valve and so that's going to
be at the same height for right about the fifth intercostal space but at the midclavicular line
so here is your clavicle right and so right about halfway where it is between the sternum
and the acromion is the mid area so on males you can actually use the nipple as the landmark so
it's going to be immediately inferior to it right about here so I would place my stethoscope here
and I would be listening to the mitral valve and once again that's going to be s1 heavy so
lub dub so just to review apartment M is going to be the aortic valve at the second intercostal on
the right side the sternal border the pulmonary on the left side of the sternal border at the second
intercostal space the tricuspid valve at the fourth or fifth intercostal space on the right
on the left sternal border and the mitral valve at the fifth intercostal space on the midclavicular
line and one final clinical tidbit that we use is right around where the mitral valve sound is is
the point of maximum impulse or the PMI and we use this clinically when detecting kind of how hard
the heart is working so if I were to palpate here on him or on myself I would be able to feel where
my heart kind of rotates into my chest and that's going to be clinically useful to see how hard the
heart is working so if you've just exercised or if you're in the middle of exercise you'll feel your
heart really beating into your chest there and if you can't you can lean forward or to your left
and you'll hear it more so and so while you're sitting down watching lectures it'll be pretty
soft compared to when you're exercising so if you have a patient who's just sitting in your office
and it's pretty strong that can be clinically relevant so this has been an introduction to
the heart sounds and where to locate them on the chest cavity and the point of maximum impulse