01.04 Heart (Cardiac) Sound Locations and Auscultation

Overview of Heart Sound Locations

1. Heart sounds correspond to closing valves
2. Abnormal heart sounds
   1. Murmur
   2. S3
   3. S4

Nursing Points

General

1. Normal Heart Sounds
   1. Aortic – S2 > S1
   2. Pulmonic – S2 > S1
   3. Erb’s Point – best for S2
   4. Tricuspid – S1 > S2
   5. Mitral – S1 > S2
2. Extra Sounds
   1. Murmur
      1. Regurgitation – not fully closed
      2. Stenosis – not fully open
   2. S3 (just after S2)
      1. Young/athlete – normal
      2. Older – heart failure
      3. “Kentucky”
   3. S4 (just before S1)
      1. Ventricular Hypertrophy
      2. Diastolic Heart Failure
      3. “Tennessee”

Assessment of Heart Sound Locations

1. Auscultate heart sounds – 5 locations
   1. Aortic – 2nd ICS, RSB
   2. Pulmonic – 2nd ICS, LSB
   3. Erb’s Point – 3rd ICS, LSB
   4. Tricuspid – 4th ICS, LSB
   5. Mitral – 5th ICS, MCL
2. S1 murmur
   1. Aortic Stenosis
   2. Pulmonic Stenosis
   3. Tricuspid Regurgitation
   4. Mitral Regurgitation
3. S2 murmur
   1. Aortic Regurgitation
   2. Pulmonic Regurgitation
   3. Tricuspid Stenosis
   4. Mitral Stenosis

Therapeutic Management

1. Echocardiogram
   1. Endocarditis
   2. Papillary muscle rupture
   3. Vegetation on valves
2. If severe valve damage – replacement

Patient Education of Heart Sound Locations

1. Murmur may indicate pathology of valves
2. Doctor may order Echocardiogram
3. Can be benign / require no intervention
4. Worst case – requires valve replacement