![]() S2 corresponds to aortic and pulmonic valve closure during heart relaxation. X Trustworthy Source Science Direct Online archive of peer-reviewed research on scientific, technical and medical topics Go to source S1 corresponds to mitral and tricuspid heart valve closure during heart contraction. There are two normal heart sounds, S1 and S2.The diaphragm helps in auscultation of high-pitched normal heart sounds. The diaphragm is the auscultatory part of the stethoscope with the wider circumference and flat surface.National Institutes of Health Go to source X Trustworthy Source PubMed Central Journal archive from the U.S. Once the diaphragm of your stethoscope is in place, listen intently. Gentle upward displacement of the left breast must be done in women to hear the heart sounds. The heart's apex is located about two fingerwidths below the left nipple. Start auscultation with the diaphragm of your stethoscope placed at the heart’s apex. If you notice a murmur during auscultation, then check again for a thrill. Do you feel a vibration (or thrill)? If a valve is partially obstructed, you may detect this.This is subtle and largely a subjective assessment, however. What is the duration of the impulse? If the patient suffers from hypertension, the impulse will last longer.If it is enlarged, it may be located closer to the armpit. If the ventricle is normal-sized and functioning, it should be about the size of a penny. Can you feel a point of maximum impulse (PMI), which indicates the location of the left ventricle? Try to pinpoint its exact location, which is usually near the mid-clavicular line.While palpating, be aware of the following: X Research source Make sure you tell the patient what you are going to do before you begin, and explain the purpose. You hand should lay flat against the chest, fingers extended. The heel of your hand should be against the sternal border and your fingers should lie just below the nipple. Also known as palpation, place your right hand over the patient's left pectoral. It's all about technique.Feel the patient's heart. But honestly, if you can't hear lung sounds with your Lightweight, you won't hear them with an expensive Cardiology. I work with nurses who swear by those cheap yellow disposable stethoscope's for isolation patients. With practice, you can hear anything you need to with those lightweights. Tricuspid valve is something like 4th intercostal space left sternal border and mitral valve is over the API which is 5th intercostal space, left-mid clavicular line. Aortic valve is 2nd intercostal space right sternal border, pulmonary valve is 2nd intercostal space left sternal border. Here you're listening for the lub-dub sounds. When listening for valves, flip the stethoscope over to the small bell side and listen over the valve locations. You can also use the large side for Apical pulse as you're only listening for regularity and rate. If I still can't hear I'll ask them to breath a little deeper than they normally would. For breath sounds, switch the diaphragm to the large side and ask your patient to breath through the mouth at a normal rate. Here are some things that I've found help me.
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