Littmann Cardiac Auscultation Poster

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Cardiac Auscultation At a minimum, listen to the four basic auscultatory sites, first using the stethoscope’s
diaphragm and then the bell. Having a 3M® Littmann™ Stetoscope with tunable technology allows you to hear different frequencies without repositioning the chestpiece.



3 4

1 Base Right (Aortic area) Base right (aortic) is the second intercostal space to the right of the sternum. You can best hear sounds from the aortic valve in this area.
2 Base Left (Pulmonic area) Base left (pulmonic) is the second intercostal space to the left of the sternum. You can best hear sounds from the pulmonic valve in this area.
Lower Left Sternal Border
3 (LLSB) (Tricuspid area)
Left lower sternal border (tricuspid) is the fourth intercostal space to the left of the sternum. You can best hear tricuspid valve and right heart sounds in this area.
4 Apex (Mitral area) Apex (mitral) is the fifth intercostal space in the
midclavicular line. It’s easiest to hear mitral valve and left heart sounds in this area.
Learn more auscultation skills.
The 3M™ Littmann® Learning Institute App is packed with auscultation training resources that help you sharpen your ability to hear through a stethoscope. The basic version of the app is a free download from the iTunes App Store (for iOS devices) or from Google Play (for Android devices).
3M, Littmann, and the Littmann L are trademarks of 3M. © 3M 2016, 2017. All Rights Reserved.

Understanding Heart Sounds
The cardiac cycle consists of two periods: The first is a contraction (systole) and the second a relaxation (diastole). During systole, blood is ejected from the chambers of the heart and during diastole, the heart chambers fill with blood. Ventricular systole causes closure of the mitral and tricuspid valves. Cardiac sounds are named according to the sequence of occurrence and are produced at specific points in the cardiac cycle.
The initial heart sound is called the first heart sound or S1. It occurs at the beginning of ventricular systole when the ventricular volume is maximal. The S1 corresponds to a point very early in the rise of the ventricular pressure curve where ventricular pressure becomes greater than atrial pressure and the mitral and tricuspid valves close. This corresponds with the QRS complex on the ECG (electrocardiogram). On the graphic recording of heart sounds called a phonocardiogram, it is the first of the components recorded.
The second heart sound, or S2, occurs at the end of the ventricular systole, at the time of the diacrotic notch on the ventricular pressure curve. It is the second of the high frequency components recorded on a phonocardiogram. The period between S1 and S2 represents ventricular systole.

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Littmann Cardiac Auscultation Poster