Auscultation

Auscultation should begin in the mitral region:

• use the bell initially to detect the low frequency sounds of mitral stenosis or a third heart sound
• use the diaphragm to detect the higher frequency sounds of mitral incompetence or a fourth heart sound

Using the bell and diaphragm, listen in the following locations detailed in the submenu:

• tricuspid area
• pulmonary area
• aortic area

The patient should now be repositioned:

• lie the patient in the left lateral position:
  • assess the apex beat
  • auscultate in the mitral area
• sit the patient forwards in full expiration:
  • palpate for thrills over the left sternal border
  • auscultate for murmurs from aortic regurgitation

Dynamic auscultation should now be performed.

Accurate and sensitive auscultation of the praecordium requires experience. Learning is made easier by mentally separating out the different sounds and analysing a single sound over several beats.