Hello! I'm Dr.Saucier, a cardiologist dedicated to helping you understand the essentials of a cardiac physical exam. Whether you're a patient curious about what doctors do during your exam or a healthcare professional in training, this guide will help you grasp the basics. Let's dive in!

1. Understanding Cardiac Auscultation

Cardiac auscultation is the practice of listening to the sounds of your heart using a stethoscope. It's a key part of any cardiac exam and helps doctors detect heart problems. Here’s what you need to know about the main areas we listen to:

• Aortic Area: Located at the second space between your ribs on the right side of your chest. This is where we check for issues like aortic stenosis.

• Pulmonic Area: Found on the left side of your chest at the second rib space. We listen here for problems with the pulmonic valve.

• Tricuspid Area: Located at the fourth or fifth rib space on the lower left side of your chest. This area helps us detect tricuspid valve issues.

• Mitral Area: Usually found at the fifth rib space, near the middle of your collarbone. Here, we listen for mitral valve problems.

Doctors use both the diaphragm and the bell of the stethoscope. The diaphragm picks up high-pitched sounds, while the bell is better for low-pitched sounds.

2. Identifying Heart Murmurs

Heart murmurs are sounds made by turbulent blood flow in the heart. There are two main types:

• Systolic Murmurs: Occur between the first heart sound (S1) and the second heart sound (S2). For example, a murmur heard in the aortic area may indicate aortic stenosis.

• Diastolic Murmurs: Occur between the second heart sound (S2) and the next first heart sound (S1). A murmur in the mitral area may suggest mitral stenosis.

Doctors use a memory aid called "Mr. Sass, Ms. Dar" to remember which murmurs are systolic and which are diastolic:

• Mr. Sass (M R S A S): Mitral Regurgitation and Aortic Stenosis are Systolic.

• Ms. Dar (M S D A R): Mitral Stenosis and Aortic Regurgitation are Diastolic.

3. Measuring Jugular Venous Pressure (JVP)

JVP is an important measure of fluid levels in the body and can indicate heart problems like fluid overload. To measure JVP:

• Positioning: The patient should be lying at a 30 to 45-degree angle.

• Observation: We look for the highest point of pulsation in the neck, near the internal jugular vein.

A JVP greater than 3-4 centimeters above the sternal angle suggests elevated pressure, which could indicate heart issues.

4. Checking the Hepatojugular Reflex

The hepatojugular reflex is a sign of heart failure. It’s tested by pressing on the liver area for 10 seconds and observing changes in the jugular vein.

5. Palpation Techniques

Palpation involves feeling the chest to assess heart function:

• Apical Impulse: Normally felt in the 5th rib space near the middle of your collarbone. A strong or displaced impulse can signal left ventricular hypertrophy.

• Heaves and Thrills: Heaves are lifts of the chest wall, and thrills are vibrations. Both can indicate serious heart conditions.

Final Thoughts

Remember, these techniques are just a starting point. Regular practice helps doctors refine their skills. If you have any questions or need more information, feel free to ask your doctor during your next visit.