First auscultation point in different countries during heart auscultation

Just wonder what first point of auscultation does your doctor places his stethoscope head while begins your heart auscultation? Different countries had different auscultation beginnings. For example doctors in some Eastern Europe countries always begin with mitral valve or PMI. Also they listen to the heart only on PMI area or on mitral valve area to get know if it beats properly. The USA doctors begin with aortic valve as I see in head to toe assessments in youtube. What else you know about the first head auscultation point in different parts of the world?

I dpubt that it has anything to do with the country. Wherever you go, different doctors will have their own way of doing it. It varies according to the individual doctor, who instructed the doctor in auscultation, and how thorough the doctor is. Some doctors will start at aortic, then pulmonic, then Erb's, then tricuspid, then mitral (this is my practice when I steth a woman), others will start at mitral and work up. Some doctors, especially with female patients who have no indication of a heart problem, are not very thorough with heart auscultation--they may just stick the steth down the shirt for a five second listen at Erb's point. Most of the women whose hearts I have listened to have told me that they had never had a doctor listen to their hearts that thoroughly. Obviously, a doctor who suspects a heart problem is going to listen longer and more thoroughly than one who does not,

My doctor always starts at the aortic and then moves on to pulmonic but that's it for most visits. I had her listen to all spots one time and back then she also started at aortic.

I never thought it differed by country. I'm pretty sure it's the same pattern throughout.

I wouldn't think it depends on the country. It moreso depends on the listener and their preference.

My doc usually starts in the mitral area

I'd guess the starting point depends on how they were taught as medical students. I'm not convinced that it depends on the country.

It has nothing to do with country. It has to do with training. My internist usually starts with he aortic.

I was taught never to listen to the lungs and heart over clothing regardless of the gender of the patient. It can be a bit awkward with female patients, but for the more modest incline I auscultate under their top or gown.

Auscultating via clothing does muffle and add additional breath sounds cause by the movement of the diaphragm on the material, which can mast other more quieter breath sounds, murmurs etc . where I work ITU ( ICU is the US version) you do need to listen for these and be aware of them.

This is how I was taught to perform a cardiac auscultation :

Where to place your stethoscope:

Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position.

The 4 percordial areas are examined with diaphragm, including:

Aortic region (between the 2nd and 3rd intercostal spaces at the right sternal border) (RUSB – right upper sternal border).

Pulmonic region (between the 2nd and 3rd intercostal spaces at the left sternal border) (LUSB – left upper sternal border).

Tricuspid region (between the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border) (LLSB – left lower sternal border).

Mitral region (near the apex of the heard between the 5th and 6th intercostal spaces in the mid-clavicular line) (apex of the heart).

After this initial examination in the supine positions, several additional maneuvers should be accomplished in the thorough cardiac exam, as follows:

Instruct the patient to turn onto their left side (left decubitus position) and listen with the bell of the stethoscope at the apex for mitral stenosis (low pitched diastolic murmur).

Instruct the patient to sit upright and re-examine the 4 percordial regions, again with the diaphragm of the stethoscope.

Instruct the patient to lean forward, exhale, and hold their breath. Listen with the diaphragm between the second and third intercostal spaces at the right sternal (aortic) and left sternal (pulmonic) areas for aortic regurgitation.

Ideally, for Respiratory examination, the patient would be sitting.

Auscultate from side to side and top to bottom. Omit the areas covered by the scapulae.

Usually the APEX of the lungs bilaterally (2cm superior to medial 1/3 of clavicle)

Superior Lobes anterior (2nd intercostal space mid clavicular line) and posterior (Between C7 & T3)

Inferior Lobes bilaterally anterior (6th intercostal space, mid-axiallary line) and posteriorly (between T3 & T10)

Middle lobe right anterior only (4th intercostal space mid-clavicular line)

Compare one side to the other looking for asymmetry and note the location and quality of the sounds you hear.

Technique

Ask the patient to disrobe, as this will allow the stethoscope to be placed directly on the chest.

Make sure the patient is sits upright in a relaxed position, where this is possible.

You should then instruct the patient to breathe a little deeper than normal through the mouth.

The bell/diaphragm of the stethoscope is then placed against the chest wall.

Auscultation of the lungs should be systematic, including all lobes of the anterior, lateral and posterior chest.

The examiner should begin at the top, compare side with side and work towards the lung bases.

The examiner should listen to at least one ventilatory cycle at each position of the chest wall.

The examiner should identify four characteristics of breath sounds: pitch, amplitude, distinctive characteristics and duration of the inspiratory sound compared with the expiratory sound.

In Europe, in general my doctor listen to my heart only in one or two spots, and that are mitral valve or tricuspid. Most of the time doctor puts head of his stethoscope under my left nipple or in the midle of my chest, around tricuspid valve, and listen there for 30 seconds or more. Count my pulse or just listen If my heart is beating normal.

Yeah in training you will hear APE To Man,

Aortic

Pulmonic

Erbs

Tricuspid

Mitral

Last time I had a doctor listen to my heart I remember him doing the order that's been talked about here: aortic, pulmonic, erbs point, tricuspid, mitral. I knew what they all were by then 😃 That was about thirteen years ago. Going right back to when I was a kid, the only exam I remember in such clarity was the favourite one of mine I had when I was 9, I've talked about it in other posts although I don't think I've gone into detail about the points, so here's what I can remember: the doctor on that occasion started with my mitral valve - I wouldn't have known it was called that, of course, but I remember that point because it was the one below my left nipple and perhaps that's why it still feels like my favourite point, because that's where he started I got a load in my pants pretty well instantly. He then did what I now know is erbs point next. Where it went from there I don't remember with any clarity, but i do remember thinking that when he put the stethoscope higher up on my chest he must have been listening to my breathing, because I always thought that lower down was where you listened to the heart based on where I used to put my hand on my chest and where I used to use a toy stethoscope on myself, but knowing what I know now those higher points might have been aortic and pulmonic as well. I also remember that this wasn't done with a pediatric stethoscope, I definitely remember it being an adult sized one, and he only listened with the diaphragm, because I always used to wonder what the other side (the bell) was for and never got it used on me as a kid so never knew the answer.

Whenever I've been stethed in the UK my doctor has always listened in the following order

Aortic

Pulmonic

Erbs

Tricuspid

Mitral