Procedure for Assessing the Heart

1. To examine the heart stand at the right side of the patient.

2. Position the patient in SUPINE position with the upper body raised at 30°.

3. INSPECTION

a. Look for proportion, pulsation, retraction, hives

b. Look for apical impulse @ 5th ICS, left midclavicular line

4. PALPATION

a. Using your fingertips, palpate for pulsation or heart sound

b. Look for systolic impulse

- While keeping the finger at the 4th ICS

- Place additional finger tips at the 4th and 5th ICS.

- If impulse is present note for location, duration, amplitude.

Note: If the patient has enlarged anterior-posterior diameter

Palpate at the right ventriculo impulse high in the epigastric

area.

c. Look for Apical impulse.

- Use your palm and finger to palpate

- Check for the following:

Findings

Location - 5th interspaces at Left

midclavicular line
Amplitude - Small and gentle tap
Duration - may last for the first 2/3 of sytole
 Note: If you cannot feel the apical pulse, asked your patient to roll to his left side
and try again.

5. PERCUSSION

> estimate heart size by percussion, starting @ the 3 rd, 4th, 5th, interspaces, starting
at the far left.

FINDINGS: pulmonary reasonance laterally and cardiac dullness medially.

6. Auscultation Sequence:

1. Place the diaphragm of stethoscope at the

Placement Assessment

R 2nd interspaces CR, rhythm, murmur,

L 2nd interspaces Splitting S2, comes and goes

with respiratory.

L sternal border (3rd, 4th, 5th, apex) S1 and S2, S2 is louder than
 S1, louder in the pulmonic

Area.

2. Place the Bell of the stethoscope at

Mitral - S1 is louder than S2,

(Closure of Mitral valve)

- 1st heart sound us best heard.

“LUB”

Tricuspid - S1 sounds split

(Closure of Mitral valve)
Aortic and pulmonic

Auscultation of S3 and S4
S3 and S4 are best heard with the bell of the stethoscope. Auscultation over the
cardiac apex in the left lateral decubitus position is preferable for identification of left
ventricular S3 and S4.

1. Position the patient to the left side

2. Locate the apical pulse.
3. Place the stethoscope
S3

 S3 is audible at light pressure and firm pressure.

S3 occurs just after the S2 sequence and may create sound of “Kentucky”
called gallop ( an abnormal S3 and S4 tend to be louder
and of higher pitch).

 S3 occurs as passive ventricular filling begins after actual relaxation is completed

 S3 can be heard and recorded in healthy young adults. However, it is usually
abnormal in patients over the age of 40 years, suggesting an enlarged ventricular
chamber.

S4
 S4 occurs just before S1 and may create s sound sequence of “TEN-NES-
SEE”.
 Aortic murmur “swishing or blowing sound.
 S4 can be heard in many healthy older adults without any other cardiac
abnormality due to decreased ventricular compliance with age.
 An S4 is heard in the vast majority of patients during the acute phase of
myocardial infarction.