During auscultation , separate heart valves are first heard: mitral - at the apex of the heart, aortic valve - in the second intercostal space to the right of the sternum, pulmonary valve - in the second intercostal space to the left of the sternum and tricuspid valve - at the base of the xiphoid process of the sternum (Fig. 2) . The heart is also listened to at the Botkin-Erb point (the place of attachment of III – IV ribs to the sternum on the left), where noises associated with lesions of the aortic valve are often detected. If during auscultation in these five points deviations from the norm are found, it is necessary to carefully listen to the entire region of the heart.
Normally, during auscultation of the heart, two tones are heard. The first tone is formed during cardiac systole with contraction of the heart muscle and the collapse of the atrioventricular valves; the second tone occurs during diastole during the slamming of the valves of the aorta and pulmonary valves. Tones are separated by pauses; between the first and second tones, the pause is shorter than between the second and the first. Sometimes during diastole, it is possible to listen to additional third and fourth cardiac sounds, which are formed during the filling of the ventricles with blood. In young, thin subjects, the third and fourth tones can be heard with a healthy heart ; in older people, they usually indicate myocardial damage (see Gallop rhythm ).Go
The sound of heart tones depends both on the state of the heart itself and on the state of the organs and tissues surrounding the heart. The sound of heart tones decreases with weakening of the myocardium, with accumulation of fluid in the pericardial cavity, with emphysema of the lungs , etc. The tones become louder during intensive work of the heart (physical and nervous tension, diffuse toxic goiter , etc.). Sometimes the sound is changed only one tone. Thus, the first tone at the apex weakens when the mitral valve is insufficient, the aorta valve is inadequate, and it increases with mitral stenosis. The second tone over the aorta and the pulmonary trunk is amplified in cases where the pressure rises in these vessels. With increasing pressure in the aorta, the second tone is enhanced above the aortic valve (accent of the second tone over the aorta). With increasing pressure in the pulmonary artery, the accent of the second tone is determined above the valve of the pulmonary trunk. Sometimes there is a split or splitting of tones, most often associated with non-simultaneous systole of the right and left ventricles or non-simultaneous slamming of the aorta valve and pulmonary trunk.
In pathological processes, heart murmurs can occur (rarely they can be in healthy ones). Pathological heart murmurs occur either when the constriction of the valve hole, or during deformation of the heart valves, which, when closed, do not give the full closure of the hole. There are systolic noise (see) and see diastolic noise (see), depending on the appearance of noise in systole or diastole.
Systolic murmur occurs when there are insufficiency of bicuspid and tricuspid valves, with narrowing of the mouth of the aorta and pulmonary trunk, etc.
see Diastolic noise - with narrowing of the atrioventricular openings, aortic and pulmonary valve insufficiency, etc.
With pericarditis (see), you can hear the pericardial friction noise. Noises that are not associated with pathology of the heart sometimes occur with a decrease in blood viscosity and an increase in blood flow velocity (with anemia, diffuse toxic goiter). After auscultation of the heart, vessels are heard, especially of the neck, over which noise is sometimes found (for example, systolic murmur over the carotid arteries during narrowing of the aorta mouth, murmur over the jugular veins with anemia).
Blood pressure is determined by sphygmomanometry (see). Normally, the arterial pressure in the brachial artery in people aged 20-40 years is on average 120/70 mm Hg. st. (see Blood pressure).