Like all patient assessments, the assessment of the cardiovascular system and heart needs to be done in a systematic manner. Each patient should have the same general pattern of assessment and technique used. Developing a good technique for listening to the heart prevents key information from being missed, and helps the practitioner organize their thoughts and assessment of the heart.
Ideally you should listen to the heart with the stethoscope against the patient’s skin. This is especially important if you have a low quality stethoscope. After examining the patient’s chest you want to identify some key landmarks to help you identify where to place your stethoscope. This is where a strong base of anatomy comes in.
The best mnemonic to remember the pattern to auscultate the heart is APE TO MAN. These letters stand for the best points to listen to various points of the heart. They don’t correspond to the exact anatomical location of the various valves.
A- Aortic Valve (right of sternal border in 2nd intercostal space)
P-Pulmonic Valve (left of sternal border in 2nd intercostal space)
E-Erbs Point (left of sternal border in 3rd intercostal space)
T(o)- Tricuspid Valve (left of sternal border in 4th intercostal space)
M(an)-Mitral Valve (left of sternum along mid-clavicular line in 5th intercostal space)
Start with the Aortic valve and then work towards the mitral valve. Stopping to listen in each area to the various valve sounds.
Follow this pattern: