Apical Heart Sound vs. Pulmonic or Aortic area... Why use Apical?

[Mindylane]

Hi everyone. I am just wondering why the apical heart sound is preferred when determining heart rate over the pulmonic or aorta heart sounds? My thinking is that the apical is the strongest, and the pulmonic/aortic sounds would be more indicative of the S2 sounds rather than the entire HR... does this make sense?

Thanks!

[BSNbeauty, BSN, RN]

I thought it was because it is the loudest. However, when I worked cardiac ICU we had to assess all locations for heart sounds.

[nurseprnRN, BSN, RN]

S2 isn't just "indicative" of the aortic and pulmonic valve sounds, it IS the sound that occurs when the aortic and pulmonic valves close in diastole.

S1 is the sound of the mitral (and tricuspid) close on systole.

The reason you should assess all cardiac regions for heart sounds (and especially in CCU) is to see if all the valves are functioning normally (murmurs if they aren't, and the timing (systole or diastole) tells you whether they are telling you about stenosis or regurg or both. You also listen for S3 and S4 for indicators of ventricular function/failure.

If all you are listening for is heart rate, it doesn't matter at all what you listen to so long as it's loud enough to hear. You might have to check around if the pt has atrial fib to make sure you catch all the quieter ones.

[nurseprnRN, BSN, RN]

S2 isn't just "indicative" of the aortic and pulmonic valve sounds, it IS the sound that occurs when the aortic and pulmonic valves close in diastole.

S1 is the sound of the mitral (and tricuspid) close on systole.

The reason you should assess all cardiac regions for heart sounds (and especially in CCU) is to see if all the valves are functioning normally (murmurs if they aren't, and the timing (systole or diastole) tells you whether they are telling you about stenosis or regurg or both. You also listen for S3 and S4 for indicators of ventricular function/failure.

If all you are listening for is heart rate, it doesn't matter at all what you listen to so long as it's loud enough to hear. You might have to check around if the pt has atrial fib to make sure you catch all the quieter ones.

[Roseyposey]

You should listen at all areas - aortic, pulmonic, tricuspid, mitral. You are not merely counting S1 and S2, you are looking for clicks, gallops, murmurs, rubs, S3, S4, etc. You should know where these landmarks are so you can identify with reasonable certainty what it is that you are hearing. I was taught the mnemonic "all physicians take money" to remember the sites.

[netglow, ASN, RN]

[video=youtube;66_63-wnqpc]

[Mindylane]

I LOVED that doctor's video -- thanks for reposting.

I appreciate all of the responses, I was just wondering why the apical pulse was the BEST pulse for Heart Rate, but I guess it is because it is the loudest. We of course have learned to listen to ALL of the heart sounds... thanks!

[netglow, ASN, RN]

I think dude's a nurse...

[Blue Cat]

That video taught me more than my 3rd semester cardiac instructor taught us! I loved it! Thank you for posting it.

Blue