Physical Exam: Auscultation – Basic Diagnostic Techniques

00:00 Let’s talk about auscultation. Of course you want to auscultate the heart to see if there’re murmurs or valve problems and so forth. But you also want to put your stethoscope over various blood vessels because, just like a garden hose when you bend it and you get that sound of the turbulent flow in the garden hose, the same thing happens in a blood vessel.

00:24 When it’s narrowed, the blood velocity increases, there’s turbulent blood flow on the other side of the narrowing and you get with each systole – with each squeeze of the ventricle – you get a sound called a bruit, from the French word meaning noise, over that vessel.

00:42 Let me give you an example. If there were a narrowing in the carotid artery and I put my stethoscope here over the carotid artery, what I would hear with each beat of the heart is this: whoosh, whoosh, whoosh, whoosh. That tells me that there’s turbulent flow secondary to a severe narrowing in the carotid artery. And you can also listen in the mid-abdomen for bruits because of narrowing in the aorta or the renal arteries. And you can also listen in the groin for narrowings in the femoral artery.

01:15 So it’s important to listen to each of these areas to see if a bruit is present because the bruit implies that there’s significant arterial narrowing or stenosis that is leading to an area of turbulent blood flow that makes the sound of the bruit.

01:37 Now, again, where are we going to listen? We’re going to listen over the carotid arteries.

01:43 We’re going to listen of course over the heart to hear if we hear any murmurs that suggest valve problems. We’re going to listen over the abdominal aorta and we’re going to listen over the femoral artery in the groin.