heart sound(s)

Sequence of cardiac examination: 1) patient supine with head elevated 30 degrees a) inspect & palpate precordium b) palpate point of maximum impulse (PMI) - diameter, location, amplitude, duration 2) patient in left lateral decubitus a) point of maximum impulse (PMI) if not previously felt b) listen at apex with bell of stethoscope 3) patient supine with head elevated 30 degrees a) listen at tricuspid area with bell of stethoscope b) listen at all ausculatory areas with diaphragm of stethoscope 4) sitting, leaning forward, after full exhalation a) listen along left sternal border & at apex b) enhances murmur of aortic insufficiency

Specific

distant heart sound; muffled heart sound ejection click first heart sound (S1) fourth heart sound (S4) heart murmur midsystolic click opening snap (OS) second heart sound (S2) third heart sound (S3), S3 gallop

General

physiologic process sign/symptom

References

Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 284