Heart and Lung Auscultation Lecture 2 PDF

Heart and Lung Auscultation Dr. VanWye, PT, DPT, PhD Board-Certified Clinical Specialist in Cardiovascular and Pulmonary Physical Therapy Objectives 7250.8 – Demonstrate a complete and safe cardiovascular and pulmonary physical therapy evaluation in a simulated environment including aerobic c...

Heart and Lung Auscultation Dr. VanWye, PT, DPT, PhD Board-Certified Clinical Specialist in Cardiovascular and Pulmonary Physical Therapy Objectives 7250.8 – Demonstrate a complete and safe cardiovascular and pulmonary physical therapy evaluation in a simulated environment including aerobic capacity/endurance, anthropometric characteristics, assistive technology, balance, circulation, cranial and peripheral nerve integrity, environmental factors, gait, integumentary integrity, joint integrity and mobility, mental functions, mobility, motor function, muscle performance, neuromotor development and sensory processing, pain, posture, ROM, reflex integrity, sensory integrity, skeletal integrity, ventilation and respiration. Normal Heart Sounds Closing of the valves S1: AV valves closing = ventricular systole S2: SL valves closing = ventricular diastole  Abnormal Heart Sounds S3 (Ventricular gallop) Occurs after S2 Blood is sloshing in, creating turbulence and an extra sound Systole dysfunction Why? Enlarged ventricle chamber that is weak and overly compliant  Abnormal Heart Sounds S4 (Atrial gallop) Occurs before S1 Blood hits resistance, creating turbulence and an extra sound Why? Thick and overly stiff heart muscle Diastolic dysfunction Abnormal Heart Sounds – Pericardial Friction Rub Abnormal Heart Sounds Murmur Vibration from turbulent flow Blowing, whooshing, or rasping sound heard during a heartbeat Common causes are valve dysfunctions or septal defects  Stethoscope Diaphragm is better for high frequency S1 S2 Bell is better for low frequency S3 S4 Heart Auscultation Patient is supine, breathing normally Can perform seated Explain procedure Place the diaphragm on the skin over 4 locations (APTM) All Physical Therapists Move (APTM) Repeat with the bell at all four locations Heart Auscultation Aortic – Right, 2nd intercostal space, parasternal Pulmonary – Left, 2nd intercostal space, parasternal A P Tricuspid – Left, 5th intercostal space, parasternal T M Mitral (apex) – Left, 5th intercostal space, midclavicular Heart Auscultation Documentation “Normal S1 and S2, with regular rate and rhythm. No splitting of the heart sounds heard. No murmur. No S3 or S4, no friction rub.”  Normal Lung Sounds Vesicular Peripheral lung fields Soft, low-pitched Inspiration sound > Expiration No pause between inspiration and expiration  Normal Lung Sounds Bronchovesicular Manubrium, right and left main bronchus Inspiration sound = Expiration No pause between inspiration and expiration  Normal Lung Sounds Bronchial Trachea Harsh, high-pitched Expiration sound ≥ Inspiration Pause between inspiration and expiration Abnormal Lung Sounds Bronchial When heard in peripheral lung fields Peripheral lung fields filled with fluid Consolidation due to pneumonia Decreased or absent Elderly, obese, emphysema, pleural dysfunction Adventitious Lung Sounds Crackles (aka rales) – Discontinuous sounds High-pitched (Fine): Fire popping, Velcro Atelectasis, pulmonary fibrosis (dry) Low-pitched (Coarse): Bubbling, glass grinding Pulmonary edema or secretions (wet) Adventitious Lung Sounds Wheezes (aka rhonchi) – Continuous sounds High-pitched (Fine): Musical, wind blowing Common in obstructive lung disease Low-pitched (Coarse): Snoring, gurgling Common in obstructive lung disease Rhonchi are aka low-pitched wheezes  Adventitious Lung Sounds Pleural Friction rub Leather on leather sound Inflamed pleural Lung Auscultation Ideally, the patient is positioned in sitting Explain the procedure Instruct patient to take deep breaths Let the patient rest after 5-6 breaths Auscultate over each area shown Listen during the entire breathing cycle Lung Auscultation Do not auscultate: Through clothing Over bony areas Too low (kidneys) Be careful not to allow the stethoscope tubing to rub against the patient, yourself, or furniture Lung Auscultation – Charting “Vesicular breath sounds in all peripheral lung fields; no rales, wheezes, or friction rub.” “High-pitched inspiratory crackles heard over bilateral lower lobes. Vesicular breath sounds in all other peripheral lung fields.” Change after treatment? References Hillegass E. Essentials of Cardiopulmonary Physical Therapy. 5th edition. Elsevier; 2022. Reid WD, Chung F, Hill K. Cardiopulmonary Physical Therapy: Management and Case Studies. 2nd ed. SLACK; 2014.