Heart Auscultation
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Purpose: Auscultation of heart sounds is used to detect pathology of the valves, pericardium, congestive heart failure, or cardiac hypertrophy, which necessitates need for referral and/or modification of physical therapy plans of care and treatment.
Procedure: Supine
Normal findings:
Abnormal Findings: Aortic valve pathology: using auscultation at aortic area a murmur will be heard; murmur heard during systole=stenosis; murmur heard during diastole=insufficiency Pulmonic valve pathology: using auscultation at pulmonic area; listen for S2; S2 listen with diaphragm at upper left sternal border S2 splits on inspiration (normal); abnormal splitting—(on exhalation) can mean RBBB, pulmonary stenosis, ASD, or mitral valve regurgitation, increased sound with HTN or pulmonary HTN; decreased aortic or pulmonary stenosis; murmur heard during systole=stenosis; murmur heard during diastole=insufficiency Tricuspid valve pathology: using auscultation at tricuspid area a murmur will be heard murmur heard during systole--tricuspid regurgitation; murmur heard during diastole--tricuspid stenosis Mitral valve pathology, detect CHF, detect ventricular hypertrophy/HTN: using auscultation by auscultating at apical/mitral area At this area listen for S1; S1—listen with diaphragm of stethoscope at the apex of the heart; listen for S4 and S3 with bell of stethoscope Split S1: RBBB; ASD, valvular defects; increased sounds can mean mitral stenosis, decreased sound—severe LV dysfunction, L BBB; murmur heard during systole--mitral regurgitation, during diastole--mitral stenosis; S3: indicates heart failure (correlate with pulmonary crackles), pericarditis, volume overload, can hear it in pregnancy; correlate with other findings; S4: indicates HTN, coronary artery disease, aortic stenosis, MI, CABG, cardiomyopathy, pregnancy, will not hear with a-fib Pericardial pathology: by auscultating heart hear a grating sound during systole and diastole that does not change with breathing; sign of pericardial effusion/inflammation |
References
Hillegass, E. (2016). Essentials of cardiopulmonary physical therapy. Elsevier Health Sciences.
Frownfelter, D., & Dean, E. (2014). Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice. Elsevier Health Sciences.
Watchie, J. (2009). Cardiovascular and pulmonary physical therapy: a clinical manual. Elsevier Health Sciences.
Hillegass, E. (2016). Essentials of cardiopulmonary physical therapy. Elsevier Health Sciences.
Frownfelter, D., & Dean, E. (2014). Cardiovascular and Pulmonary Physical Therapy: Evidence to Practice. Elsevier Health Sciences.
Watchie, J. (2009). Cardiovascular and pulmonary physical therapy: a clinical manual. Elsevier Health Sciences.
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