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Hi, here we are in the simulation center.
And Megan, one of our course
instructors, is going to demonstrate to us the relationship between some basic
heart anatomy and what clinicians listen for in, physical examinations.
>> Thank you so much for being here today.
It's always exciting to talk about the heart.
What we're going to cover today is just a review of the
anatomy that Dr. Scanga has already gone over with you about the
heart's position in the chest cavity, and we're going to learn about assessing
the heart rate, and we're also going to talk about auscultating heart sounds.
>> Megan, can you clarify for everyone what auscultating, or auscultation means?
>> Auscultation is just a clinical term that we
use to refer to listening to the internal sounds
of the body, typically with a stethoscope, and we
just think it's important to use those technical, clinical terms.
And also what you hear through your own ear listening to the
body is very different once you hear when you use the stethoscope.
Does that make sense?
>> Yeah.
>> Okay.
So first, let's talk about just where the heart is positioned in the chest cavity.
As you should remember, the heart is just deep to
the sternum, and positioned slightly to the left of the midline.
So about two-thirds of the heart is here to left of the midline.
And in terms of where the heart is in there, we like to think about the ribs.
So there's one, two, three, four, five.
And it's important to know that the apex, or this pointy tip of
the heart, is located just about between the fifth and the sixth ribs.
So it would be something about, like this.
Also the apex is tilted a little towards the anterior portion of the chest cavity.
So anterior just means the front portion of the chest.
And sometimes, that rests right against the
chest wall and kind of on the diaphragm.
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So when we are listening with a stethoscope on
the chest one thing that we're, using to assess the
heart rate, is the point of maximal impulse, and that's
where that apex is resting against the anterior chest wall.
And that's the most accurate place to check the heart rate.
Yeah?
>> Now why would you want to listen to it rather than just feel it?
>> That's a good question.
Palpating it, you're able to count the heart rate, which we usually
talk about in terms of how many beats there are per minute.
But when you auscultate, you're also able to listen, to other
things at the same time, in addition to just the heart rate.
So you can listen, to the heart sounds.
>> You mentioned the word palpating.
What does that mean?
>> Palpate just means to feel, so you can
feel the heart rate at that point of maximal impulse.
>> Megan, did you want to listen on one of the student's hearts?
Could you demonstrate on one of them?
>> That'd be great.
[NOISE].
>> All right, so I'm just going to listen at the point of maximal impulse.
That's that spot between the fifth and sixth rib that you mentioned?
>> Correct.
>> Okay.
>> [SOUND] It sounds like your
heart rate is just about
75 beats per minute.
And when I'm listening, I'm also able to hear the basic heart sounds.
So, by that I mean S1 and S2.
Do you remember what those are?
>> I think I do.
>> Okay.
>> So S1 is when the AV valve is
closed, and then S2 is when the semilunar valve's closed.
>> Correct, so S1 makes the sound, the lub sound, and S2 is the dup
sound, that you should remember learning about with doctor Scanga.
>> Sometimes when I'm laying down on my left side I feel
like a pulse on my, chest wall, is that the maximum impulse is?
>> Yeah, sometimes just, if you're on your, in the left
lying position, you can actually feel the heart against your chest wall.
So, the other thing that why it's good to listen and
not just to feel for the heart rate at the point of
maximal impulse is in addition to the basic S1 and S2, if
somebody had abnormal heart sounds, you would be able to hear that.
And so in addition to listening in that one spot,
a lot of times, clinicians will listen in multiple locations.
And again, that just brings us back to why it's so
important to understand how the heart is positioned in the body.
If you remember learning about the heart valves, [COUGH] hopefully, you'll
know that the aortic valve then, if it's positioned like this is
in the chest, would be right about here towards the top
portion of the chest and just to the right of the sternum.
The, pulmonic valve would be just to the left of
the sternum, and again at the top of the chest.
The tricuspid valve would be, lower down, on
the chest wall to the right of the sternum.
And the mitral valve would be lower down on
the chest wall and to the left of the sternum.
So knowing that, we're able to listen, to somebody's
heart and isolate what's going on in different locations.
So, if somebody was having a problem with one of those particular valves, as you
listened, it would be, easier to hear it
in, in those certain locations as I discussed.
>> Megan, I actually have a mild problem with my mitral valve.
Should we see if the students can hear it?
>> I think that's a great idea.
>> Here.
Let's make this easy.
>> Sure.
>> Now everybody will be able to listen.
>> That'd be great.
So, you go ahead and listen and, and tell me if you hear anything.
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>> Mitral, right?
>> Yeah.
[SOUND].
>> I think I hear it, but I'm not sure.
[SOUND].
>> Yeah, there's definitely a murmur.
>> Okay.
>> It can take a little practice, so if you're
not sure at what you're hearing the first time, that's normal.
Well we have the rest of lab to practice.
[LAUGH]
>> And the other thing to know is that different valves, different type of
valve problems would have different sounds, and
so you can listen for that as well.
So a valve that doesn't close all the way
might make a swishing sound or a [SOUND], whereas
a valve that has a, doesn't open all the
way might make more a clicking sound, like, [NOISE].
A little hard to demonstrate, but as you listen,
try to also not just listen to see if it
sounds different from S1 and S2, but if you can
kind of tell what type of abnormal sound you're hearing.
>> Great, thank you so much, Megan.
>> Thanks for being here.
>> We're going to be back in a little while to see more demos.
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