Listening (auscultation) is a diagnostic method that is performed using a stethoscope or phonendoscope. Listening information helps make a diagnosis. One of the main instruments a doctor needs when examining a patient is a stethoscope. It is also used in obstetrics to listen to fetal heart sounds. A stethoscope is an hourglass-shaped wooden or plastic tube, one end of which is applied to the patient's heart and the other to the doctor's ear.
In modern medical practice More often, a phonendoscope (a modernized version of a stethoscope) is used, consisting of a funnel with a reinforcing membrane and two rubber tubes, the ends of which are inserted into the doctor’s ears. The funnel is applied to the patient’s body; the membrane, like the eardrum of the ear, captures and transmits sound waves through the tubes directly to the doctor’s ear. With the help of these devices, the doctor can hear what is happening in the patient's body.
Auscultation is most often used to examine the lungs, heart, and blood vessels. Listening helps to determine the disease by the sounds made by the organs abdominal cavity.
Auscultation of the lungs
When a healthy person inhales and exhales air, so-called vesicular breathing is heard. When listening to the lungs, it is determined whether this breathing is normal or altered due to illness, whether there is respiratory tract noises, wheezing, appearing with the accumulation of mucus and pus. With abnormal (painful) breathing, dry and moist wheezing is especially alarming. Moist rales appear in the pulmonary alveoli and resemble gurgling water. An experienced doctor can distinguish pneumonia from pulmonary edema by wheezing, as well as bronchial asthma from bronchitis. In bronchial asthma, wheezing is especially clearly audible when exhaling.
Listening to the heart
During auscultation of the heart, certain points were discovered, when listening to them with a phonendoscope, one could hear the four heart valves working. If the heart is healthy, only the first and second sounds are heard (the heard heart sounds resemble a galloping horse).
If additional tones or noises appear, they usually indicate painful changes in heart function. Sometimes noise is heard between the first and second tones. If it is sonorous and high, then its cause is most often a narrowing heart valve(valve stenosis). This way, the doctor can hear the heart pushing blood through the narrowed blood vessel. A quiet and relatively low noise is a symptom of a leaky heart valve (prolapse); the doctor hears how blood moves in the opposite direction when the heart contracts.
Auscultation of arteries
Auscultation of arteries is used to measure blood pressure. Older people often experience narrowing of arteries (for example, arteries in the brain or lower limbs). By pressing the phonendoscope, for example, to blood vessels neck, a noise is heard that appears when blood flows under pressure through a narrowed area.
Auscultation of the intestine
A phonendoscope is the main tool for assessing bowel function. If the stomach is healthy, then upon auscultation, irregular low sounds resembling rumbling are heard throughout the entire abdominal cavity. If the patient has an intestinal obstruction, then when listening to the abdominal cavity no sounds are usually heard, this is often a symptom dangerous disease. The doctor evaluates loud rumbling or gurgling as intense bowel activity (most often this is a symptom of an intestinal infection).
The characteristics of the auscultated tissues assessed depend on the condition of sound transmission from its source, located deep in the lung, to the doctor’s ear. Dense fabrics conduct sound better than soft ones, while airy fabrics conduct sound poorly.
Auscultation of the lungs is performed along all lines and intercostal spaces, similar to percussion. It is carried out in two stages:
- indicative auscultation, when the entire surface of the lungs is listened to;
- targeted auscultation, when suspicious areas are listened to in detail.
To assess the nature of breathing, nasal breathing is used, and to assess adverse respiratory sounds - breathing open mouth. During targeted auscultation, the patient should be asked to cough. It should be borne in mind that due to the forced air flow, wheezing may appear or its intensity may change. Bronchophony is also used in a similar way to percussion.
Most common reasons artifacts and errors during auscultation of the lungs are: pronounced hair growth, tremor (shaking)
body by various reasons (low temperature indoors, chills, parkinsonism, etc.), while muscle noises, noises from clothing and bed linen are heard.
Normal auscultatory pattern
Vesicular respiration occurs due to oscillatory movements of the elastic walls of the alveoli when they are tense at the height of inspiration. Listened to most of inhalation and the beginning of exhalation (the latter due to vibrations of the afferent bronchioles). The sound is gentle, silky, reminiscent of the letter “f”. It is heard from behind and on the lateral surface, to a lesser extent - above the upper sections.
Sources of bronchial breathing covered with huge masses of alveolar tissue. The main source of bronchial breathing is the glottis, which can change its configuration and lumen and cause air turbulence. This sound resonates at the bifurcation of the trachea, main and lobar bronchi. Biophysicists believe that the source of sound can only be a bifurcation in which the difference in cross-section between the bronchus and bifurcants is equal to or greater than 4 cm. A rough inhalation and a rough and sharp exhalation, reminiscent of the letter “x,” are heard. Normally it is heard above the jugular notch.
The causes of bronchial breathing in pathology are:
- lobar or almost lobar compaction of the lung tissue, when due to the compaction sound is not formed, but is conducted through it;
- a large cavity in the lungs, exceeding 4 cm in diameter, with a relatively narrow opening through which it communicates with the bronchi. The mechanism of bronchial breathing in this case is associated with air turbulence in the cavity and the passage connecting it to the bronchus. Amphoric breathing may occur (extremely rare) in the case of a cavity large sizes and with dense smooth walls.
Hard breathing- a special type of vesicular breathing - characterized by equally audible inhalation and exhalation.
Causes of hard breathing:
- heard in a limited area of the lung with focal compaction of the lung tissue;
- over the entire surface of the lungs is often heard during bronchitis, when, due to inflammation, the walls of the bronchi become thicker and their mucous becomes rougher. Exhalation in the conditions described above lengthens and intensifies.
Quite often in clinical practice There is a variant of hard breathing with prolonged exhalation during spasm or phenomena of bronchial obstruction.
As an option for hard breathing, bronchovesicular breathing can be considered, which can be heard on the right above the collarbone. The reason for this phenomenon is anatomical features the right main bronchus, which is shorter and wider than the left.
Sometimes stridor is detected - a breathing sound that occurs when there is obstruction or compression of the trachea or large bronchi during inspiration. Occurs with tumors of the respiratory tract.
Crepitus
The phenomenon of crepitation is understood as the sound of the walls of the alveoli coming apart when they lose surfactant and the appearance of liquid exudate, which is rich in fibrin, which sharply increases adhesion, i.e., gluing of the walls of the alveoli. Thus, crepitus is a purely alveolar phenomenon. The separation of the alveoli occurs at the height of inspiration, therefore crepitus is heard only at the height of inspiration. The sound of crepitus is prolonged, multiple, homogeneous, reminiscent of the sound produced by rubbing hair over the ear. Most often, crepitus is observed at the beginning lobar pneumonia(the so-called crepitacio index) and at its end (crepitacio redux). Elderly patients who have been lying down for a long time may have physiological crepitus.
Crepitation must be differentiated from moist rales:
- wheezing can be of different sizes, crepitus is always uniform;
- wheezing is heard more long time than crepitus, which is observed for about a day and then disappears;
- wheezing, as a rule, is more localized, crepitus is abundant and occupies a large area;
- wheezing is longer than crepitus, relative to the act of breathing (figuratively speaking, crepitus resembles an explosion);
- coughing does not affect the timbre and duration of crepitus, but these same characteristics of wheezing change.
Bronchophony- is the conduction of vibrations created by colloquial speech or whispers in the glottis, which are carried out along bronchial tree and pulmonary structures to the site of auscultation. That is, the mechanism of bronchophony is similar to the mechanism of vocal tremor; the bronchophony technique repeats the technique of lung auscultation.
If spoken language is used to study bronchophony, it should be borne in mind that it is normal conditions is heard in the form of a vague buzzing over the area of bronchial breathing. When studying bronchophony through whispering under normal conditions, the same results are obtained as when using spoken speech. However, if there is a focus of compaction of the lung tissue, words spoken over it in a whisper become unclearly distinguishable. Listening to whispers is thought to be more sensitive than listening to voiced speech. In severely ill patients who are unable to loudly pronounce the phrase necessary to study vocal tremor, bronchophony can be performed without difficulty.
Diagnostic methods such as percussion, palpation, and auscultation of the heart, which are outdated at first glance, do not lose their relevance today. Listening to the patient's cardiac activity using a phonendoscope is actively used for initial diagnosis, both in prehospital stage at acute conditions, and in hospitals and clinics. Today, experts recommend performing auscultation sequentially at five main points, which allow the tones of a working organ to be distinguished in as much detail as possible.
Auscultation at certain points of the chest makes it possible to determine such indicators of cardiac activity as the frequency and rhythm of contractions, the presence of noises that are normally absent, the purity and melody of the sound of the heart, and heart tones. In this case, inaccurate application of the phonendoscope can significantly distort the sounds heard, which can lead to an error in diagnosis.
It is important! The search for the necessary points is carried out by palpation in the corresponding anatomical areas. However, specialists with extensive experience are able to detect with maximum accuracy the necessary places for listening visually, without resorting to palpation.
When performing auscultation, the degree of hairiness of the patient's chest is important. A significant layer of hair can make auscultation impossible even with proper placement of the necessary points.
Location and search for heart auscultation points
The examination points correspond to the projection of the heart valves on chest, as well as places where studying their work is most convenient and productive. The conduction of noise is also influenced by the blood flow in the vessels, which leads to the formation of a certain sound-conducting effect.
Listening to the patient’s cardiac activity is carried out in a strict sequence corresponding to the list below:
- Apex impulse. This point is the first auscultated area, and allows you to evaluate the work of both the mitral valve and the atrioventricular orifice on the left. Searching for it is carried out visually or with the help of hands. In cases where there is no visible apex beat, the doctor resorts to the percussion method. In this case, the boundaries of the heart are determined by tapping, and the phonendoscope olive is set to the boundary of the relative dullness of the heart. While listening, the patient is asked to hold his breath after inhaling and exhaling.
- The second listening point is determined in the area of the second intercostal space to the right of the sternum. As in the first case, the study is carried out after the patient holds his breath while exhaling. Here the work of the aortic valves and the aortic valve is determined.
- The third point is the area of listening to the operation of the valve apparatus pulmonary artery. It is determined in the area of the second intercostal space to the left of the sternum. It is important that after examination at the third point, it is necessary to repeat the first and second stages of the procedure. All three points of cardiac auscultation should have the same volume of heart sounds.
- The fourth research point is located in the area xiphoid process the sternum and the attachment point of the fifth rib to it. The examination performed here reveals pathology of the tricuspid valve and atrioventricular orifice on the right.
- The fifth point is an additional area for listening to the functioning of the aortic valves. It is located in the area of the third intercostal space to the left of the sternum. The examination is also carried out while the patient exhales while breathing is held.
It is important! The research on the above points is standard, aimed at the initial diagnosis. If there is any suspicion of pathological process Auscultation is also performed with the patient in the lateral position. In this case, the examination begins from the first point, after which the phonendoscope is shifted to the anterior-axillary and mid-axillary line. This measure makes it possible to achieve a clearer sound of noise, which contributes to a more accurate diagnosis.
In some cases, the technique of auscultation of the heart is also used after physical activity. In this case, listening is performed first at standard points, and then along the entire projection of the heart, determining the ability of noise to be carried beyond the contour of the organ, as well as the direction of their conduction. Thus, the murmur of the tricuspid valve, as a rule, is diverted to the right, the mitral valve is diverted to the left, and the murmur of the aorta radiates to the carotid arteries.
Assessment of noise at auscultation points
Pathological noises, the presence of which was determined during listening, are subject to a certain assessment by a specialist. Thus, the time of their occurrence (during systole or diastole), the localization and conduction of noises, their volume, timbre, and duration are determined. Diagnostic value It also depends on the position of the patient’s body in which the murmur is heard better, as well as its dynamic characteristics (increase, decrease). 
When assessing detected murmurs, it is important to take into account the age of the patient being examined. Yes, for children younger age characterized by good auscultation of three to four heart sounds, which is not a pathology. At the same time, a similar phenomenon in adults in most cases indicates the presence of severe heart disease. Besides this, there are other age characteristics work of the cardiovascular system, failure to take into account which can lead to an erroneous diagnosis with subsequent incorrect treatment.
Auscultation (listening) is one of the main methods of clinical examination of a patient, which consists of listening to sound phenomena that spontaneously arise in the body.
In practice, both direct or direct auscultation is performed (listening directly with the ear attached to the patient’s body) and indirect auscultation using a stethoscope or phonendoscope. With direct auscultation, audibility is much better than when using a stethoscope, since the auscultated noises are not distorted; for example, weak bronchial breathing, see in aortic insufficiency, is sometimes caught only in this way.
For indirect auscultation, solid stethoscopes made of wood, or flexible binaural stethoscopes, consisting of a funnel and two rubber tubes, a stethophonendoscope, and a phonendoscope are used (Fig. 1-3). The stethoscope is a closed acoustic system; it is the main conductor of sound, especially in a flexible stethoscope; in the case of communication with outside air or the lumen of the tube is closed, auscultation becomes almost impossible. When a solid stethoscope is placed into the auricle, the conduction of sound through the bones is of some importance. When auscultating with a stethoscope, noises are more or less distorted due to resonance, but better noise delineation is provided of different origins in a small area (for example, during auscultation of the heart); Noises are perceived more clearly.
Auscultation is of exceptional importance in examining the lungs, heart and blood vessels, measuring blood pressure according to Korotkoff, and determining bowel sounds.
Rice. 1. Plastic stethoscope. Rice. 2. Binaural stethoscope. Rice. 3. Stethoscope.
Auscultation (lat. auscultatio - listening) is one of the main methods clinical trial, which consists of listening to sound phenomena that spontaneously arise in the body.
Auscultation was studied and introduced into medical practice by K. Laennec. The nature of acoustic phenomena detected during auscultation depends on physical properties(density, tension, mass) of oscillating bodies, anatomical structure and intensity of organ function. Vibrations of tissue structures occur during the act of breathing, contraction of the heart, movements of the stomach and intestines; Some of the vibrations reach the surface of the body (skin). Every point on the surface of the body is a source sound wave, spreading in all directions; As you move away from the sound source, the wave energy is distributed over increasingly larger volumes of air, so the amplitude of vibrations quickly decreases, and the sound becomes so quiet that it is not perceived by the ear that is not in contact with the body. The main significance of the stethoscope, as well as the direct application of the ear to the body, is that it prevents the sound from being attenuated by dissipating energy.
All sounds occurring in the body are noises, that is, a mixture of sounds of different frequencies. The ear is most sensitive to sounds around 2000 Hz. As frequency decreases, sensitivity decreases sharply, so that at the same intensity, high-frequency sounds seem louder than low-frequency sounds. The ear can more easily detect changes in frequency or pitch than in sound intensity. A weak sound after a strong one is difficult to perceive; In addition, in a mixture of sounds of different frequencies, strong vibrations of one frequency mask weaker vibrations of other frequencies.
The sounds perceived during auscultation of the lungs and heart do not exceed 1000 Hz in frequency. The ear only picks up about 10% of the vibrations caused by the heart ( normal heart is a source of oscillations with a frequency of 5 to 800 per 1 sec.), since some of the oscillations are too low frequency (below 20), i.e. below the threshold of perception (infrasounds), and some are of low intensity. Nevertheless, the importance of auscultation is very great. Phonocardiographic studies have confirmed the explanations for almost all sound phenomena of the heart (tones, noises) established by clinical auscultation (see Phonography).
In practice, both direct or direct auscultation is used, as well as indirect auscultation using a stethoscope, phonendoscope, etc. With direct auscultation, audibility is much better than when using a stethoscope, since the auscultated noises are perceived directly by the auricle and are not distorted. For example, weak bronchial breathing and diastolic murmur in aortic insufficiency are sometimes detected only with this method. V.P. Obraztsov proposed an original method of direct auscultation for recognizing an additional tone during a gallop rhythm. A necessary condition This method of auscultation involves tightly pressing the ear to the area of the heart, in which a closed air cavity is formed and the first heart sound and gallop rhythm acquire the character of a ringing sound due to the push of the heart against the chest, since the gallop rhythm is a tone-push.
For indirect auscultation, solid stethoscopes made of wood, plastic or flexible binaural stethoscopes, consisting of a funnel and two rubber tubes, stethophonendoscopes and phonendoscopes are used.
The stethoscope is a closed acoustic system, and the air in it is the main conductor of sound, especially in a flexible stethoscope; in the case of communication with outside air or the lumen of the tube is closed, auscultation becomes almost impossible. When the solid stethoscope is pointed towards auricle The conduction of sound through the bones of the skull is of some importance. When auscultating with a stethoscope, noises are more or less distorted due to resonance, but better localization and delimitation of noises of different origins in a small area is ensured (for example, during auscultation of the heart); Noises are perceived more clearly. A necessary condition for successful auscultation is silence in the room or office.
Auscultation is an indispensable method of clinical research. It is of exceptional importance in examining the lungs, heart and blood vessels, measuring Korotkoff blood pressure, determining bowel sounds, examining joints, etc.
Auscultation of the heart is considered the most accurate of the most informative methods diagnosis of diseases of this organ. Note that the doctor performing the listening must have excellent hearing, but more importantly, be able to listen, that is, recognize noise by amplitude and time. Auscultation – the most complicated method diagnosing diseases of the cardiovascular system.
Exist certain rules conducting research. Data is sampled at five points. During diagnostics, a stethoscope (phonendoscope) is used.
The invention of the device and the emergence of the method
The stethoscope at first was a rigid tube for one ear. The history of medicine owes its invention to the invention of the device and the advent of a method for listening to the heart to the French doctor Rene Laennec. In 1816, he invented the stethoscope, and just a year later he described his experience in the work “Indirect Auscultation”. The main symptoms were discovered and systematized by this Frenchman.
Monaural wooden tubes have been in common use for over a century. In the first half of the twentieth century, rural doctors and paramedics continued to use this model.
After the release of binaural instruments, doctors made several more observations. For example, the murmurs of mitral stenosis (low-frequency sounds) are better heard through a bell-shaped stethoscope. Whereas aortic insufficiency (sound at high frequencies) is more clearly distinguished when using a membrane tip. In 1926, a binaural phonendoscope with a combination head was released.
The next step in improving the design of the device was the invention of electronic auscultatory instruments: stethoscopes with the ability to amplify sound, filter noise, as well as sound “visualization” (phonocardiograph).
Data obtained by physical examination patient, are not only signs of diseases, but also give a more complete picture of the functionality circulatory system person:
- determination of pressure when filling chambers;
- volemia;
- the nature and extent of valve pathologies;
- localization of lesions in the system, and so on.
This not only improved the possibility of making a diagnosis, but also contributed to the prescription of more adequate therapy.
Goals and objectives of the study
The main purpose of diagnosis is to recognize a patient’s heart disease through analysis of its rhythm. While working, the organ is in constant tension, its individual parts move at a certain frequency, promoting the “dispersal” of the blood mass. Due to this movement, vibration occurs, reaching the surface of the chest through the adjacent soft fabrics. You can listen to them. Using the heart auscultation technique, doctors:
- assess the nature of the sounds “produced” by the heart muscle during operation;
- characterize them;
- identify the causes of their occurrence.
First of all, the doctor checks in a certain order heart rate at standard points. If changes have been identified and a number of accompanying symptoms indicating pathology are observed, additional listening is carried out:
- the whole area of absolute cardiac dullness;
- area above the sternum;
- left axillary fossa;
- interscapular space;
- sleepy and subclavian artery(on the neck).
Standard procedure
The rules for conducting the study are quite simple. Preparation is required in rare cases: if the patient has a lot of hair on his chest, then before auscultation the hair is moistened with water or greased. Sometimes the listening areas need to be shaved.
The first stage of the procedure is carried out in a sitting or standing position. The algorithm is then repeated with the patient lying down. He is required to take a deep breath, exhale and hold his breath for a moment. Sometimes special techniques are used:
- several gymnastic exercises;
- listening while lying on your side;
- listening when inhaling, straining.
Certain segments are listened to one by one: the standard algorithm is five points, with additional assignments - other areas.
Auscultatory zones of the heart
Auscultation points are examined in the following order:
- Apex impulse point: area of the mitral valve and left atrioventricular orifice;
- The point of the second intercostal space is the right edge of the sternum: the region of the valve and the mouth of the aorta;
- The point of the second intercostal space is the left edge of the sternum: the region of the pulmonary valve;
- A point in the lower third of the sternum at the base of the xiphoid process and the place of attachment of the V-shaped rib to the right edge: the area of the tricuspid valve and atrioventricular foramen;
- The point of the third intercostal space is the left edge of the sternum: the area of the aortic valves.
Heart auscultation points 1st zone. Palpation of the area where the apex beat is located. If it cannot be palpated, the left border of the relative dullness of the heart is determined by percussion. Installation of a phonendoscope. The tool is applied to the identified point. The patient takes a deep breath, exhales and does not breathe for 3-5 seconds. Next, you need to listen to sounds, identify and evaluate them.
The first tone appears after a long pause, the second tone - due to a short one. The first tone, moreover, is consonant with the pulsation carotid artery(palpation is performed). The norm corresponds to twice the volume of the first tone. If it is higher than twice, strengthening is stated; weaker or equally – weakening. Sometimes the rhythm is determined in three keys.
The triple tone of a healthy (normal) heart is more often observed in pediatric patients. In adults, only in the period of 20-30 years of age can one hear three tones. But they have other noises: the rhythm of a quail, the rhythm of a gallop, the bifurcation of the first tone.
2nd zone. Palpation of the second intercostal space on the right, installation of the device. The patient inhales and exhales while holding his breath. And again the researcher hears two-tone consonance.
What is heard is assessed by the volume of the second tone:
- stronger – the condition is normal;
- lower or equal – weakening at this point;
- fuzzy echo – splitting;
- clear two sounds in one - bifurcation.
3rd zone. Palpation of the second intercostal space on the left, installation of the device. The patient takes a deep breath, exhales and holds his breath for a few seconds. Here, as in the study of the 2nd point, one listens to the second tone. Normally, tone II is louder. Deviations are considered by analogy with the previous zone. Next, repeated auscultation is performed to compare the amplitude of the sound of the second tone. If there is a strong increase in the volume of this tone, the emphasis shifts to the aorta or pulmonary artery.
4th zone. Palpation is performed at the indicated point, and a phonendoscope is installed. Inhale and exhale again, holding your breath. The tonality indicators are similar to the assessment of heart sounds at the first point, that is, healthy person here the first tone is louder than the second.
5th zone. The researcher repeats all the steps:
- palpation in a specific area to determine the point of installation of the phonendoscope;
- command the patient to inhale and exhale and hold his breath;
- listening to sounds, identifying tones and evaluating them.
In the area of the aortic valves, the sound strength of both tones in a healthy person is approximately the same. Deviations in the ratio at this point have no specific meaning when making a diagnosis. Noises between tones are defined as:
- systolic (in the interval between the I and II sounds);
- diastolic (in the interval between the II and I sounds).
Changing the sonority of tones
A weakening or strengthening of the tone indicates many things. For example, a change in the sound of tone I occurs due to:
- decreased airiness of lung tissue;
- paralytic or barrel-shaped, thick chest;
- chest emphysema;
- effusion in the pericardial area;
- damage to the heart muscle;
- myocarditis, cardiosclerosis;
- destruction of valves, reduction in the amplitude of movement of the valves;
- mitral and tricuspid insufficiency;
- reducing the rate of pressure rise in the cavities of the ventricles.
Strengthening of the first tone is observed with mitral stenosis, and so on.
Change in the sound of the second tone: a short-term emphasis on increasing is observed with emotional outbursts, excessive excitement, and also as a symptom of hypertension. A decrease in the sound intensity of the second tone is a sign of aortic valve insufficiency.
At the 3rd point, an increase in the volume of the second tone is always with mitral stenosis and other heart defects of any nature.
In addition to tonality, auscultation makes it possible to listen pathological sounds, for example, clicking. They are characterized by high-pitched sound, inconsistency, and short duration.
Noise detection
If auscultation of the heart reveals murmurs in the main zones, then they are analyzed as follows:
- phase of the cardiac cycle of listening to the sound, in which part it is heard;
- duration;
- sound strength in general and sound gradation throughout the phase;
- variability (strength, timbre, duration in different body positions, respiratory periods and physical stress).
The described diagnostic measure allows you to identify health problems. In case of insufficiency, high-frequency and low-frequency auscultatory symptoms are also considered.
The latter is more often associated with the movement of blood mass, while the former is more often associated with the speed of flow. These sound vibrations are defined as noise, but this terminology also applies to tones.
As an example, consider mitral regurgitation. With this dysfunction, the left ventricle (LV) directs blood flow into the aorta and back into the left atrium (LA), therefore, the pressure in it is greater. But in the LP it’s low. The gradient of this indicator can be up to 65 mmHg. This means that with mitral insufficiency, the blood flow rate is high, and the noise is defined as high-frequency.
High-frequency sound vibrations are observed with minor mitral regurgitation (valve incompetence leading to flow from the left ventricle into the left atrium due to contraction).
The presence of low-frequency noise indicates that regurgitation is pronounced, that is, insufficiency may have severe form with rupture of the chordae tendineae of the valve.
Auscultation (or the method of physically listening to the “music” of the heart), detection of changes in the sound of tones and analysis of the information obtained indicate the following:
- weakening of the first tone – insufficiency of the mitral and aortic valves;
- strengthening of the first tone – stenosis of the left atrioventricular orifice;
- weakening of the second tone – aortic valve insufficiency, hypotension;
- increased tone II – hypertension, pulmonary hypertension;
- bifurcation of the first tone – bundle branch block;
- bifurcation of the second tone – stenosis of the aortic mouth, hypertension.
Auscultation gives an idea of the noise:
- systolic – stenosis of the aorta or pulmonary trunk, mitral and tricuspid valve insufficiency;
- diastolic - narrowing of the left or right atrioventricular orifice;
- pericardial friction in pericarditis;
- pleuropericardial friction - inflammation of the pleura adjacent to the heart.
Heart - most important organ. It is very important for our health that it functions without failure! Auscultation helps to identify these failures.
