What is the order of cardiac auscultation?

Nov 08, 2024 Source: Cainiu Health

Dr. Tian Hongbo

Introduction

In general, cardiac auscultation is typically performed in the following order: mitral valve area, pulmonary valve area, aortic valve area, second aortic valve area, and tricuspid valve area. During auscultation, in addition to paying attention to normal heart sounds and murmurs in each valvular area, the physician should also evaluate other factors such as heart rate, intensity, and quality of heart sounds, to comprehensively assess cardiac health.

Under normal circumstances, cardiac auscultation is typically performed in the following order: mitral valve area, pulmonary valve area, aortic valve area, second aortic valve listening area, and tricuspid valve area. The specific analysis is as follows:

1. Mitral Valve Area

The mitral valve area is located at the point of maximal apical impulse, also known as the apex. Since the mitral valve lies between the left atrium and left ventricle, blood flows from the left atrium into the left ventricle through this valve. The first heart sound produced by mitral valve closure and the second heart sound component related to mitral valve opening can be heard in this region. Careful auscultation here allows for an initial assessment of the functional status of the left heart system.

2. Pulmonary Valve Area

The pulmonary valve area is located at the second intercostal space along the left sternal border. Blood flows from the right ventricle into the pulmonary artery through the pulmonary valve. Auscultation in this area primarily focuses on the pulmonary component of the second heart sound generated by pulmonary valve closure, as well as murmurs caused by pathology of the pulmonary valve itself. Detailed examination of this area helps detect abnormalities in the right ventricular outflow tract and pulmonary valve.

3. Aortic Valve Area

The aortic valve area is located at the second intercostal space along the right sternal border. Blood passes from the left ventricle into the aorta through the aortic valve. Here, the aortic component of the second heart sound produced by aortic valve closure and murmurs resulting from aortic valve pathology can be heard. This area plays a significant role in evaluating the function of the left ventricular outflow tract and the aortic valve.

4. Second Aortic Valve Listening Area

The second aortic valve listening area is located at the third intercostal space along the left sternal border. Auscultation in this area is primarily used to further evaluate diastolic abnormalities such as aortic regurgitation, aiding in more accurate diagnosis of aortic valve disease.

5. Tricuspid Valve Area

The tricuspid valve area is located at the lower part of the left sternal border. Blood flows from the right atrium into the right ventricle through the tricuspid valve. In this region, the tricuspid component of the first heart sound (produced by tricuspid valve closure) and the second heart sound (related to tricuspid valve opening), as well as murmurs due to tricuspid valve pathology, can be heard. Auscultation here helps assess the functional status of the right heart system.

During auscultation, physicians must not only pay attention to normal heart sounds and murmurs in each valvular area but also consider other factors such as heart rate, rhythm, intensity, and quality of heart sounds, integrating all findings to comprehensively evaluate cardiac health.

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