A stronger apex beat on the right hemithorax is abnormal. Some breed variation in the location of the apical impulse is normal. Known as the apical impulse, it is normally felt on the left hemithorax at about the fifth to sixth intercostal space. Locate the heartbeat against the chest wall. To begin the auscultation, start by palpating the precordium, or the outside of the thorax over the area of the heart. Your auscultation should be done in a relatively quiet place to ensure background noises do not interfere. You should take your time, since rushing will virtually guarantee missing subtle sounds. The most important part of the stethoscope is the bit between the earpieces. Electronic stethoscopes are available, but their high cost is prohibitive for most veterinary technicians.ĭuring the auscultation, you should be completely focused on the heart sounds. Your stethoscope should also have comfortable earpieces. A neonatal stethoscope is helpful with puppies and kittens.
Using the bell side requires a very light touch, as too much pressure will tense the skin, causing it to act like a diaphragm. The extra pressure allows the hair to rub on the diaphragm, making it difficult to hear the low-frequency sounds made audible by the bell. With the combination stethoscope head, extra pressure must be applied to "get through" the hair coat. The diaphragm allows for easy auscultation of high-frequency sounds, and the bell is designed for soft, low-frequency sounds.Ī separate bell side is more useful in veterinary medicine than a combined diaphragm and bell side because of the patient's hair. Select a reputable manufacturer and a high-quality model.įeatures of a good stethoscope include short (25 inches or less) double-lumen tubing, a brass or high-quality steel head with both large and small diaphragms, and a bell. The adage, "You get what you pay for," is true when purchasing a stethoscope. It's worthwhile to invest in a top-quality stethoscope for good cardiac auscultation. While we will focus on murmur and heart sounds, keep in mind that you will also need to listen for arrhythmias, some of which might be transient.įirst, let's discuss the right equipment. These terms are often misused, so it's important to clarify their proper usage. A standard nomenclature has been developed to simplify the process, which includes a grading scale for rating murmur loudness, descriptors of murmur quality and location, and names for transient cardiac sounds. You should have no problem hearing most cardiac murmurs and relaying your findings to the doctor in an organized, concise fashion. Since you are usually the first member of the clinical team to examine the patient, it's very important for you to understand the cardiac sounds when you perform the initial evaluation. Combined with a thorough history, this information is used to guide further diagnostics. And an accurate physical examination is the principal source of information about a patient's condition. Cardiac auscultation is an important part of the physical examination.
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