1. Areas of AuscultationChapter 5 Ara G. Tilkian, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS

2. Outline • Traditional Areas of Auscultation • Left Ventricular Area • Right Ventricular Area • Left Atrial Area • Right Atrial Area • Aorta Area • Pulmonic Area

3. Traditional Areas of Auscultation • Mitral Area –Cardiac Apex • Tricuspid Area-4th & 5th intercostal space of left sternal border • Aortic Area-2nd intercostal space of the right sternal border • Pulmonic Area-2nd intercostal space left sternal border

5. Left Ventricular Area • Aortic component of the 2nd heart sound A2 • Cardiac Apex and extends laterally in the 3rd and 4th interspaces to left sternal border in one direction & to the anterior axillary line in the other.

6. Right Ventricular Area • Tricuspid Stenosis or regurgitation, pulmonary regurgitation and ventricular septal defect.

7. Left Atrial Area • Mitral Regurgitation • Anterior chest-listen left of apex • Posterior left thorax-area between the spine and the border of the scapula at the level of its tip

8. Right Atrial Area • Tricuspid insufficiency is best heard at the right sternal border in the 4th and 5th interspaces.

9. Aortic Area • Aortic Ejection Click and A2 • Aortic stenosis & Insufficiency • Increased aortic flow • Dilatation on the ascending aorta • Abnormalities of the carotid or subclavian arteries

10. Pulmonic Area • Pulmonic Ejection & P2 • Pulmonary Stenosis & insufficiency • Increased pulmonary flow & stenosis • Patent Ductus arteriosus PDA

11. THE ENDOFCHAPTER 5 Tilkian, Ara MD Understanding Heart Sounds and Murmurs, Fourth Edition, W.B. Sunders Company. 2002, pp. 43-48.