Physical Examination

Session Four: Heart Sounds

Cheryl A. Walters, M.D.
(VH Dissector Pro Images: Lawrence Rizzolo, Ph.D.)

1. Learning Objectives

2. Student Prep

Read pp. 390-399, 407-429, Chapter 14 The Heart

Inspection: Identify on yourself or partner the aortic (2nd Right intercostal space), pulmonic (2nd Left ICS), tricuspid (4th L ICS), and mitral (5th L ICS) areas and Erb’s point (3rd L ICS). Identify the sternal angle or angle of Louis (helpful in measuring JVD).

Auscultation: Read the attached article, “Listening to the Heart: Dying Art?” Listen to the recording of heart sounds on the CD. Practice using the diaphragm of your stethoscope to listen to your own or partner’s heart to identify the first (S1) and second (S2) heart sounds, and the systolic and diastolic phases.

Three defining features are helpful in discriminating S1/S2, systole/diastole:

The apical heartbeat (often visible in thin, young patients, and palpable in many patients esp. in the left lateral decubitus position) coincides with S1. The carotid upstroke is just after S1.

3. Clinical Anatomical Landmarks (use ctrl-p or command-p to reveal or hide the plane of the axial image)

The internal jugular pulsation is beneath the sternocleidomastoid muscle and is sometimes visible by shining a light on the overlying tissue at an angle. The vein itself is not visible.

The external jugular vein is visible lateral to the sternocleidomastoid muscle.