Heart Sounds First heart sound Second heart sound “Lubb”- ventricles contract and both AV valves close Second heart sound “Dupp”- semilunar valves close at end of ventricular systole Systole is between first and second sounds. Diastole is between second and first sounds. http://www.stethographics.com/main/physiology_hs_i ntroduction.html

Listening to the Heart 1 Hold the diaphragm over the patient’s heart. Position the diaphragm on the left upper part of the chest where the 4th to 6th ribs meet, almost directly under the breast. Hold the stethoscope between your pointer and middle fingers and apply enough gentle pressure so that you don’t hear your fingers rubbing together. 2 Listen to the heart for a full minute. Ask the patient to relax and breathe normally. You should hear the normal sounds of the human heart, which sound like “lub-dub.” These sounds are also called systolic and diastolic. Systolic is the “lub” sound and diastolic is the “dub” sound.[20]The “lub,” or systolic, sound happens when the mitral and tricuspid valves of the heart close. The “dub,” or diastolic, sound happens when the aortic and pulmonic valves close.

Count heartbeats 3 Count the number of heartbeats you hear in a minute. The normal resting heart rate for adults and children over 10 years old is between 60-100 beats per minute. For well-trained athletes, the normal resting heart rate may only be between 40-60 beats per minute.[21]There are several different ranges of resting heart rates to consider for patients under 10 years old. Those ranges include:[22] Newborns up to one month old: 70-190 beats per minute Infants 1 - 11 months old: 80 - 160 beats per minute Children 1 - 2 years old: 80 - 130 beats per minute Children 3 - 4 years old: 80 - 120 beats per minute Children 5 - 6 years old: 75 - 115 beats per minute Children 7 - 9 years old: 70 - 110 beats per minute

Abnormal 4 Listen for abnormal heart sounds. As you count the heartbeats, you should also listen for any abnormal sounds. Anything that does not sound like lub-dub may be considered abnormal. If you hear anything abnormal, your patient may need further evaluation by a doctor.[23]If you hear a whooshing sound or a sound that is more like “lub...shhh...dub,” your patient might have a heart murmur. A heart murmur is blood rushing quickly through the valves. Many people have what are called “innocent” heart murmurs.[24] But some heart murmurs do point to issues with heart valves, so you should advise your patient to see a doctor if you detect a heart murmur.[25] If you hear a third heart sound that is like a low frequency vibration, your patient might have a ventricular defect. This third heart sound is referred to as S3 or a ventricular gallop. Advise the patient to see a doctor if you hear a third heart sound.[26] Try listening to samples of normal and abnormal heart sounds to help you determine if what you are hearing is normal.

Listening to the Lungs 1 Ask your patient to sit straight up and breathe normally. As you listen, you can ask the patient to take a deep breath if you cannot hear breath sounds or if they are too quiet to determine if there are any abnormalities. 2 Use the diaphragm of your stethoscope to listen to your patient’s lungs. Listen to the patient’s lungs in the upper and lower lobes, and on the front and back of the patient.As you listen place the stethoscope on the upper part of the chest, then the midclavicular line of the chest, and then the bottom part of the chest. Make sure to listen to the front and back of all of these regions. Make sure to compare both sides of your patient’s lungs and note if anything is abnormal. By covering all of these positions you will be able to listen to all of the lobes of your patient’s lungs.[27]

Lungs 3 Listen for normal breath sounds. Normal breath sounds are clear, like listening to someone blowing air into a cup. Listen to a sample of healthy lungs and then compare the sounds to what you hear in your patient’s lungs.There are two types of normal breath sounds:[28] Bronchial breath sounds are those heard within the tracheobronchial tree. Vesicular breath sounds are those heard over the lung tissue. 4 Listen for abnormal breath sounds. Abnormal breath sounds include wheezing, stridor, rhonchi, and rales. If you do not hear any breath sounds, the patient may have air or fluid around the lungs, thickness around the chest wall, or airflow that is slowed down or over inflation to the lungs.[29]There are four types of abnormal breath sounds: Wheezing sounds like a high pitched sound when the person exhales, and sometimes when they inhale as well. Many patients who have asthma also have wheezes, and sometimes you can even hear the wheezing without a stethoscope.[30] Stridor sounds like high-pitched musical breathing, similar to wheezing, heard most often when the patient inhales. Stridor is caused by a blockage in the back of the throat. This sound can also often be heard without a stethoscope.[31] Rhonchi sounds like snoring. Rhonchi cannot be heard without a stethoscope and happens because the air is following a “rough” path through the lungs or because it is blocked.[32] Rales sounds like popping bubble wrap or rattling in the lungs. Rales can be heard when a person inhales.[33]

Listening to Abdominal Sounds 1 Place the diaphragm on your patient’s bare stomach. Use your patient’s belly button as the center and divide your listening around the belly button into four sections. Listen to the upper left, upper right, lower left and right. 2 Listen for normal bowel sounds. Normal bowel sounds sound like when your stomach growls or grumbles.Anything else may suggest that something is wrong and that the patient requires further evaluation. You should hear “growling” in all four sections. Sometimes after surgery, bowel sounds will take a while to return.[ 3 Listen for abnormal bowel sounds. Most of the sounds that you hear when listening to your patient’s bowels are just the sounds of digestion. Although most bowel sounds are normal, there are some abnormalities that could point to a problem. If you are unsure if the bowel sounds you hear are normal and/or the patient has other symptoms, then the patient should see a doctor for further evaluation. If you do not hear any bowel sounds, that may mean that something is blocked in the patient’s stomach. It can also indicate constipation and bowel sounds may return on their own. But if they do not return, then there may be a blockage. In this case, the patient would need further evaluation by a doctor. If the patient has hyperactive bowel sounds followed by a lack of bowel sounds, that could indicate that there has been a rupture or necrosis of the bowel tissue. If the patient has very high-pitched bowel sounds, this may indicate that there is an obstruction in the patient’s bowels. Slow bowel sounds may be caused by prescription drugs, spinal anesthesia, infection, trauma, abdominal surgery, or overexpansion of the bowel. Fast, or hyperactive bowel sounds can be caused by Crohn’s disease, a gastrointestinal bleed, food allergies, diarrhea, infection, and ulcerative colitis.

Listening For a Bruit 1 Determine if you need to check for a bruit. If you have detected a sound that seems like a heart murmur, you should also check for a bruit. Since heart murmurs and bruits sound similar, it is important to check for both if one is suspected. 2 Place the diaphragm of your stethoscope over one of the carotid arteries. The carotid arteries are located in the front of your patient’s neck, on either side of the Adam’s apple. If you take your index and middle finger and run them down the front of your throat, you will trace over the locations of your two carotid arteries.[44]Be careful not to press too hard on the artery or you may cut off circulation and cause your patient to faint. Never press on both carotid arteries at the same time. 3 Listen for bruits. A bruit makes a whooshing sound that indicates that an artery is narrowed. Sometimes a bruit may be confused with a murmur because they sound similar, but if the patient has a bruit then the whooshing sound will be louder when you listen to the carotid artery than when you listen to the heart.[46][47]You may also want to listen for bruits over the abdominal aorta, renal arteries, iliac arteries and femoral arteries.