 Welcome to nursing school explain and this video in the assessment series about auscultating the heart. Let's first review the heart anatomy so that we can get a better understanding of how it really relates to the physical assessment. So if we look at the heart here we have the four chambers and between the right atrium and the right ventricle we have the tricuspid valve then from the right ventricle to the lungs is the opening of the pulmonic valve when the blood returns from the lungs into the left atrium it flows through the mitral valve into the left ventricle and then to the body through the aortic valve and these valves here are color coded so that we know how that applies when we actually listen and a few certain things that are important to know when you're auscultating the patient's heart we want to use the bell of our set of scopes so make sure that you know how to use that because there are a variety of set of scopes out there and so you need to know how to use your set of scopes to be able to access the bell of it and then it is also very important to know the landmark so that you then can assess for the landmarks in the correct locations. So first we have the sternum the intercostal spaces which is basically the space in between the ribs and intercostal the clavicle which is the collarbone the mid clavicular line which is right at the center of the clavicle and then you can just follow it down and then also we have the mid axillary line which is the axilla the armpit and goes down in the straight line here and so then how does this relate to our patient so here we have our patient he is smiling and in the middle here we have his or her sternum and then we have our aortic valve here on the right side and the landmark here is the second intercostal space at the right sternum border now you might wonder you say well the aortic valve is actually down here in the patients in the coming out of the left ventricle why is it here at second intercostal space that's up quite high in the patient's chest basically where we listen for the hard sounds is where they are best heard whether the sound of the opening and the closing of these valves is best projected so it does not necessarily relate to the anatomical landmarks you're going to have to memorize where you find these landmarks to place your stethoscopes so that you can assess the hard valves correctly so again aortic valve second intercostal space at the right sternum border and then remember that the heart sits in the chest cavity more on the left side so everything else is going to be assessed on the patient's left side so that a pulmonic valve is at the second intercostal space at the left sternum border so right here at the sternum and one thing that I always see students getting confused is to find that first or second intercostal space which is also why we need to know what the clavicle is because many times the first rib actually lies underneath the clavicle so then we'll have the clavicle on the first rib kind of like in that same spot and then the second intercostal space so how to find the second rib and then find that soft spot the rib area in between and then we have here herbs point is third intercostal space at the left sternum border and you might wonder what is the significance of herbs point because it doesn't really relate to a heart valve herbs point is the point where S1 and S2 are just heard the best in the whole chest cavity and if you recall if you've ever been to a physical exam or if somebody has ever listened to your heart a physician a cardiologist any kind of provider they usually put your stethoscope right on the left side on in that third in the costal space and that is herbs point because if it's not necessary to listen to all the different cardiac landmarks this is where we can hear S1 and listen for regularity and rhythm best now then moving down we're still at that left sternum border at the fourth in the costal space now we have the tricuspid valve then we can hear it there and then for our mitral valve it's at the fifth in the costal space but now it's not the sternum border anymore now we move it over to that mid clavicular line so now we need to find the patients clavicle which usually connects to the sternum and then the acromion of the shoulder right here and find that mid clavicular line so in the middle of the clavicle and find it at that fifth in the costal space and the mitral valve is also called the point of maximum impulse as well as the apical pulse so the point of maximum impulse is where the left ventricle is located the apex of the heart since hence apical pulse and sometimes you can actually palpate the point of maximum impulse some patients is just not possible it depends on their physical makeup sometimes if there's breast tissue in the way or if there's a lot of adipose tissue it might be very difficult but if the patient is thin many times you can actually access or assess and palpate their point of maximum impulse and then what we actually do listen for is s1 and s2 which is the closure of the semi-lunar and atrial ventricular valves and we want them to be regular and we also want there to be no extra heart sounds extra swishing sounds and those would be considered s3 and s4 and that goes a little bit beyond this video so we're listening just for the closure which for that love dub love dub love dub and depending on what site you listen for or you listen at what landmark you are at it will depend on if the love or the dub is louder and you might it might sound like a love dub or then love dub it might just be a little bit different and the more you get exposed to it the better you'll get at identifying that what we are not expecting to hear is a hard murmur which is a swishing sound and that usually means that the heart valves either don't open completely or they don't close completely which then would be in valve stenosis or regurgitation and I go a little bit over the explanation in different video into that and the other thing we're listening to is rhythm and regularities so we want to have a nice regular heartbeat because then we know the heart chambers are synchronized and they are working together with the contraction the way it's supposed to be and so we want we want to really listen take some time to listen especially if you're just starting out in nursing school so that you can actually determine is the rate regular or irregular if you're detecting that it is irregular so if it sounds something like love dub love dub love the dub love the dub love the dub dub something like that or the space sound more then it is very important to listen for one full minute to determine the patient's actual heart rate because if we only listen to an irregular heartbeat for 15 seconds and multiply it by 4 or for 30 seconds and multiply it by 2 we might not get that correct heart rate because in the first 30 seconds the heart rate might be faster and in the 32nd the second 30 seconds it might be a little bit slower so if you detect that it's irregular or even if you're not sure just take your time and listen for a full minute so that you actually know what the patient's heart rate is and that is done at the apical pulse site which is also that PMI and the mitral valve location at that fifth intercostal space at the mid-clavicular line so thank you for watching this video on auscultating the patient's heart remember that the anatomical location does not correspond to the landmarks that we use when we listen to the patient's heart remember to listen for S1 and S2 rhythm and regularity as well as those anatomic landmarks and to use the bell so that you can hear the heart sounds the best thanks so much for watching this video please give me the thumbs up if you enjoyed it also watch the other videos in the assessment series that will help you become better in assessing your patient and caring for them in the best way possible thanks for watching nursing school explained see you soon