A phonendoscope and a stethoscope are indispensable attributes of a doctor, but many of us do not even guess how important they are! Listening to the patient's chest allows us to determine not only respiratory tract infections and bronchitis, but also serious cardiac dysfunction. Auscultation of the heart is one of the most common methods of diagnosing heart failure , heart defects, tachycardia, angina pectoris and other diseases.
Listening points with a technique of auscultation of the heart
In order to hear the rhythm of the heartbeats, their tone, the sounds of the heart valve and the ventricles, the procedure should be conducted in complete silence. In addition, it is important to accurately determine the listening points. A shift of even a few centimeters can lead to an error in the diagnosis. So, there are 5 basic points of auscultation of the heart:
- The first point is in the zone of the apical impulse of the heart. You can determine the place with the help of palpation. If you can not feel the push, the doctor calculates the upper limit of dullness of the heart with the help of percussion on the patient's chest. The phonendoscope should be installed exactly at the edge of deafness in the shock zone.
- The second point is at the right edge of the sternum in the second intercostal space. It is also easiest to determine by touch. Most often, the doctor examines the area with his left hand, right-handing the phonendoscope to the chest wall.
- The third point is quite simple to define, it is located in the second intercostal space symmetrically to the second point, but not to the right edge of the sternum, but to the left.
- The fourth point is not always easily accessible. It lies in the right margin of the lower third of the sternum at the base of the xiphoid process.
- The fifth, last point, entering the complex of compulsory, is in the third intercostal space near the left edge of the sternum. It, like the previous ones, can be defined by percussion method in patients with severe edema and obesity, or by palpation.
If the auscultation of the heart has shown a norm, this study ends. Otherwise, the patient is listened to additionally, lying on the left side, or using physical exertion.
What is the basis for auscultation of the heart?
At the heart of the methodology lies the ability of the heart to produce characteristic sounds during operation. This - the so-called heart tones, auscultation allows you to determine even the slightest deviations in hearing. In children, there are three tones, people over 20 years old usually hear 2 tones. In order to hear them, the doctor suggests that the patient breathe in and out and hold his breath. The first sound, which he then fixes, and will be the first tone of the heart. The second, respectively, the second. At different points of listening they can have different loudness and strength, on the basis of these data and a diagnosis is made. It happens that auscultation detects heart sounds. This means that the tone does not sound clean, the pushes are not rhythmic, drowned, there are extraneous sounds. All this - evidence of various violations of the heart and blood vessels.
But to make an accurate diagnosis, the doctor should accurately describe the noise. For this, the following actions are carried out:
- Determine which phase (systolic, or diastolic) there is noise.
- Choose the point of his best listening to find out the localization.
- Determine the best listening zone outside the main points of auscultation.
- Carry out sound research in a vertical, horizontal position, in a posture lying on the right side.
- Specify the degree of loudness of the noise, its timbre, duration and changes in dynamics.
All these data require analysis, after which a final verdict can be made.