Cardiac sounding

The cardiac sounding is the technique allowing the listening of the Cœur via a Stéthoscope.

It forms integral part of the Clinical examination of the patient.

Technique

It is made principle at a patient barechested, in a quiet environment. The patient is classically lengthened on the back ( décubitus dorsal ), but certain anomalies can better get along in sitting position or the patient lengthened on the left side ( décubitus side left ).

The principal places of listening are:

a little in lower part of the end interns right Clavicule: aortic hearth .
a little in lower part of the end interns left Clavicule: pulmonary hearth.
with the point of the heart (located with the palpation of the left part of the Thorax): apex or hearth apexien.
in inside of the preceding zone: hearth endapexien.

The recognition of the various noises or anomalies requires an assiduous practice: the anomalies are very often discrete and can escape a not accustomed Oreille.

Normal sounding

One hears with any hearth (a little more clearly with the apex) the Tap-poum , i.e. the succession of two noises (short sounds) brought closer:

the first noise, called B1, corresponds to the closing of the mitral Valve, quasi contemporary of the beginning of the contraction ventricular left, of the opening of the aortic valve and the ejection of the Sang in the Aorte. It is the end of the Diastole and the beginning of the Systole .
the second noise, called B2, of the same tonality than the first (as opposed to what can imply the expression Tap-Poum ), corresponds to the closing of the aortic valve, quasi contemporary of left ventricular relieving, the opening of the mitral valve and the filling of the left ventricle by the auricle. It is the end of the systole and the beginning of the diastole .

Phenomena parallel with those described above occurs on the level from the right heart.

One can also analyze the Cardiac rhythm (frequency, irregularity) by the cardiac sounding.

Abnormal sounding

Three types of anomalies can get along: anomalies of the physiological noises, the added again noises and the heart murmur .

Anomalies of the physiological noises

B1 and/or B2 can be duplicated, being able to testify to a shift between the right heart and the left heart, generally indices of a disease of the first, especially if it is fixed, i.e. whatever the time of breathing. A variable unfolding with the latter can be completely normal. These unfoldings is observed in the event of Bloc of branch. The unfolding of B2 can be heard in the inter-auricular Communication.

It can be perceived a " éclat" cardiac noises: the glare of B1, perceived with the apex, generally translated a sclerosis of the mitral Valve within the framework of a mitral contracting; the glare of B2 on the level of the aortic hearth within the framework of a arterial Hypertension or to the pulmonary hearth within the framework of a pulmonary arterial Hypertension.

The noises of the heart can also be deafened (by reduction in their intensity) within the framework of a épanchement pleural or a épanchement péricardiaque, of a Cardiac failure.

Added again noises

In certain cardiac pathologies, it is possible to hear a third noise, called B3 (after B2), even a fourth, called B4 (located between B3 and B1). They are commonly called gallops . These noises are thus diastolic and generally testify to a Cardiac failure. In certain cases, one can hear a noise of opening of a valve.
In the event of immobility of a valve, as one can see it for example at the time of a aortic Rétrécissement important, a noise can disappear (abolition of B2 in the quoted case).

Systolic noises

A click mesotelesystolic (medium and end of systole) can be perceived within the framework of a Prolapsus of the mitral valve.

Diastolic noises

The two types of gallop , B3 and B4, are diastolic. In the event of mitral contracting, it can be heard a mitral slapping of opening , sharp snap, close to B2, heard with the apex.

The heart murmur

It is secondary with a mode of turbulent blood flow in the heart.

It is characterized by:

its localization: hearth where he is best heard;
its temporal parameters:

systolic or diastolic (according to whether it is located between B1 and B2 or B2 and B1)
at the beginning of period: protosystolic or protodiastolic
in middle of period: mesosystolic or more rarely mesodiastolic
at the end of the period: telesystolic or telediastolic
over all the period: holosystolic or holodiastolic .

its stamp, the terminology while remaining very subjective: raspy, musical…
its irradiations: other places where it can get along, different from its principal localization;
its variation with breathing or the position.

For example, a breath of mitral insufficiency is typically described like a musical breath holosystolic with the hearth apexien.

A organic breath corresponds to an anomaly of the heart. He is opposed to the functional breath corresponding to the increase in the cardiac flow caused by the stress and thus causing small turbulences.

See also: Heart murmur

Other anomalies

The friction pericarditic is a noise continuous, systolo-diastolic, which is intended at the time of the Péricardite S. (to be distinguished from the " friction pleural" who, him, cease with the stop of breathing).

At the patient carrying a mechanical artificial valve, there exists a metal noise of opening of the latter.

Complementary techniques

the phonocardiogram is the representation of the auditive phenomena on an unrolling paper. It has a primarily teaching interest but is hardly any more used in practice current.

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