During the nursing head-to-toe assessment, the nurse will be listening to the heart with a stethoscope. Auscultating the heart allows the nurse to assess the heart’s rhythm, rate, and sound of valve closure. The nurse will be assessing S1 and S2 while noting if there are any S1 and S2 splits or extra heart sounds like S3, S4, or heart murmurs.
It is very important you are able to understand how to distinguish between S1 and S2 and what S3, S4, and heart murmurs sound like. Please see the article on “Heart Sounds Explained” for an in depth explanation on heart sounds.
In this article, you will learn how to perform an assessment of the heart. Please watch the video below for a demonstration for stethoscope placement and patient positioning.
How to Listen to the Heart with a Stethoscope
Tips for Heart Auscultation
Remember the mnemonic “All Patients Take Medicine”
Aortic: found right of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub”
Pulmonic: found left of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub”
Erb’s Point: found left of the sternal border in the 3rd intercostal space
Tricuspid: found left of the sternal border in the 4th intercostal space REPRESENTS S1 “lub”
Mitral: found left of the sternal border at the midclavicular in the 5th intercostal space REPRESENTS S1 “lub” (also the site of point of maximal impulse)
The Base of the heart includes the aortic and pulmonic areas, and S2 will be loudest at the base. Aortic and pulmonic murmurs are heard best at the base with the patient leaning forward and sitting up with the diaphragm of the stethoscope.
The Apex of the heart includes the tricuspid and mitral areas, and S1 will be loudest at the apex. S3 and S4 along with mitral stenosis murmurs will be heard best at this position with the patient lying on their left side with the bell of the stethoscope.
Patient Positioning for Heart Auscultation
Supine or sitting-up: Use the diaphragm and listen at all 5 auscultation sites (noting S1 and S2 and if there are any splits presents). In addition, distinguish S1 from S2. Then repeat with the bell of the stethoscope…noting any other extra sounds.
Left side: turn the patient onto their left side and auscultate with the bell of the stethoscope at the APEX area and listen for S3, S4, or mitral stenosis murmurs.
Sit up, lean forward, and have patient exhale: Listen with the diaphragm at the aortic and pulmonic sites for murmurs.
You may be interested in “Heart Sounds Quiz“