heart&lung sounds

Bronchophony - Abnormal

Ask the patient to say "99" several times while auscultating the chest walls. Over consolidated areas "99" is understandable. This is because acoustic filtering is reduced in consolidated lung tissue, which allows better sound transmission. Compare this breath sound to the recording in the "Bronchophony - Healthy" lesson.

Bronchophony - normal

Ask the patient to say "99" several times while auscultating the chest walls. Over healthy lung areas, "99" is not understandable. This is because sound is impeded in normal lungs. Compare this voiced breath sound to the recording in the "Bronchophony - Abnormal" lesson

Crackles - Coarse (Rales)

Coarse crackles are discontinuous, brief, popping lung sounds. Compared to fine crackles they are louder, lower in pitch and last longer. They have also been described as a bubbling sound. You can simulate this sound by rolling strands of hair between your fingers near your ear. potato chips&shards of metal

Second Heart Sound - Physiologically Split #1

During normal breathing, the timing between the aortic and pulmonic components of the second heart sound varies. This causes the second heart sound to be split. Maximum splitting occurs at peak inspiration. In the example you are hearing the splitting of the second heart sound is 60 milliseconds at peak inspiration and zero splitting at peak expiration.

Early inspiratory crackles (rales)

Early inspiratory crackles (rales), as suggested by the title, begin and end during the early part of inspiration. The pitch is lower than late inspiratory crackles. A patient's cough may decrease or clear these lung sounds. Early inspiratory crackles suggest decreased FEV1 capacity and are characteristic of COPD.

egophony

Egophony is a voice sound with a nasal quality, often described to be like a goat's bleating. Egophony has higher intensity over abnormal areas. Over healthy lung areas, egophony will not be present. Ask the patient to say "Eeee" several times and auscultate the chest walls. Over healthy lung areas, the sound is understandable as an "E". Compare this sound to the recording in the "Egophony - a" lesson. Egophony is a voiced sound with a nasal quality, often described to be like a goat's bleating. Egophony has higher intensity over abnormal lung areas. Ask the patient to say "Eeee" several times. Auscultate the chest walls. Over consolidated lung areas, the sound is heard as an "A" (aaay). Compare this sound to the recording in the "Egophony - e" lesson

Crackles - Fine (Rales)

Fine crackles are brief, discontinuous, popping lung sounds that are high-pitched. Fine crackles are also similar to the sound of wood burning in a fireplace, or hook and loop fasteners being pulled apart or cellophane being crumpled. Crackles, previously termed rales, can be heard in both phases of respiration. Early inspiratory and expiratory crackles are the hallmark of chronic bronchitis. Late inspiratory crackles may mean pneumonia, CHF, or atelectasis.

Late inspiratory crackles (rales)

Late inspiratory crackles (rales) begin in late inspiration and increase in intensity. They are normally higher pitched and can vary in loudness. These adventitious breath sounds resemble the noise made when hook and loop fasteners are being separated. These sounds are heard over posterior bases of the lungs. They may clear with changes in posture or several deep breaths. They do not clear with coughing.

Wheeze - Monophonic

Monophonic wheezes are loud, continuous sounds occurring in inspiration, expiration or throughout the respiratory cycle. The constant pitch of these sounds creates a musical tone. The tone is lower in pitch compared to other adventitious breath sounds. The single tone suggests the narrowing of a larger airway. These lung sounds are heard over anterior, posterior and lateral chest walls. These sounds can be more intense over lung areas affected by partial obstructions.

First Heart Sound (Minimally Split)

On occasion the first heart sound can be made up of two separate sounds separated by a very small interval (20-30 milliseconds). The Mitral component (caused by closure of the Mitral valve) comes first and is louder than the Tricuspid component (caused by closure of the Tricuspid valve). A minimally split first heart sound is a normal variation of the first heart sound

Pleural Rubs

Pleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound. Coughing will not alter the sound. They are produced because two inflamed surfaces are sliding by one another, such as in pleurisy. During auscultation, pleural rubs can usually be localized to a particular place on the chest wall. They also come and go. Because these sounds occur whenever the patient's chest wall moves, they appear on inspiration and expiration. Pleural rubs stop when the patient holds her breath. If the rubbing sound continues while the patient holds a breath, it may be a pericardial friction rub. spacer gif Pleural Rubs

Wheeze - Polyphonic

Polyphonic wheezes are loud, musical and continuous. These breath sounds occur in expiration and inspiration and are heard over anterior, posterior and lateral chest walls. These sounds are associated with COPD and more severe asthma

Stridor

Stridor is caused by upper airway narrowing or obstruction. It is often heard without a stethoscope. It occurs in 10-20% of extubated patients. Stridor is a loud, high-pitched crowing breath sound heard during inspiration but may also occur throughout the respiratory cycle most notably as a patient worsens. In children, stridor may become louder in the supine position. Causes of stridor are pertussis, croup, epiglottis, aspirations.

Third Heart Sound - Physiologic

The third heart sound is heard early in diastole. Along with the first and second heart sounds, this extra sound creates a gallop cadence and sounds like "tennessee." In this auscultation example the second heart sound is unsplit to make it easier for you to distinguish the third heart sound. The third heart sound is very low frequency (between 25 hz and 50 hz). Listen with the bell of the stethoscope at the cardiac apex. Asking the patient to lie on his left side will frequently increase the intensity of the third heart sound. A third heart sound is heard on occasion in normal individuals with no cardiac pathology.

First and Second Heart Sounds - Normal and Unsplit

This is a normal first and second heart sound at 60 beats per minute. You are auscultating at the Mitral valve area (Apex). The first heart sound has slightly greater intensity than the second heart sound. The first heart sound is produced by the closing of the mitral and tricuspid valve leaflets. The second heart sound is produced by the closing of the aortic and pulmonic valve leaflets. The second heart sound is unsplit when the subject is holding his or her breath at peak expiration.

Wheeze - Expiratory

Wheezes are adventitious lung sounds that are continuous with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction. Wheezes are caused by narrowing of the airways.

Innocent Murmur

This is an example of an innocent murmur. This type of murmur is seen with non-cardiac conditions such as pregnancy, hyperthyroidism, exercise and anemia. When these are treated appropriately the systolic murmur disappears. The murmur is heard in early systole, is of short duration and has a frequency range of 120 hz to 250 hz. It is best auscultated in the pulmonic area and increases in intensity with inspiration. It can be heard with either the bell or diaphragm. In this example S1 and S2 are normal. Diastole is silent. The short duration and mid-range frequency characterize an innocent murmur. spacer gif Innocent Murmur

Vesicular - Normal

Vesicular breath sounds are soft and low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over the most of the lung surface. They have an inspiration/expiratory ratio of 3 to 1 or I:E of 3:1.

Wheeze

Wheezes are adventitious lung sounds that are continuous with a musical quality. Wheezes can be high or low pitched. High pitched wheezes may have an auscultation sound similar to squeaking. Lower pitched wheezes have a snoring or moaning quality. The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction. Wheezes are caused by narrowing of the airways.

Whispered Pectoriloquy

When a patient whispers '1-2-3', the voice high frequencies, or soft vowel sounds are dampened in a normal lung. Ask the patient to whisper '1-2-3' several times while ascultating the chest walls. Over healthly lung areas, '1-2-3' is not intelligible. Compare this sound to the recording found in the "Whispered Pectoriloquy - Abnormal" lesson. Voice high frequencies are more readily transmitted to the chest wall in abnormal lungs as compared to normal lungs. Ask the patient to whisper "1-2-3" several times while auscultating across the chest walls. The lung area is abnormal if the "1-2-3" sound is understood. This is the abnormal '1-2-3'. Compare this sound to the recording found in the "Whispered Pectoriloquy - Normal" lesson.

bronchial

bronchvader Bronchial breath sounds are hollow, tubular sounds that are lower pitched. They can be auscultated over the trachea where they are considered normal. There is a distinct pause in the sound between inspiration and expiration. I:E ratio is 1:3 . Bronchial breath sounds are considered abnormal if heard over the peripheral lung fields. Bronchial breath sounds other than close to the trachea may indicate pneumonia, atelectasis, pleural effusions

Bronchovesicular

long even breaths ins/exp, slight wheezing in background, Inspiration to expiration periods are equal with bronchovesicular lung sounds. These are normal sounds in the mid-chest area or in the posterior chest between the scapula. They reflect a mixture of the pitch of the bronchial breath sounds heard near the trachea and the alveoli with the vesicular sound. They have an I:E ratio of 1:1.

Vesicular - Diminished

short exp, long insp Diminished vesicular sounds are of lower intensity and are less full or robust than vesicular sounds. These sounds can occur in patients who move a lowered volume of air, such as in frail, elderly patients or shallow breathing patients. They are also heard with obese or highly muscular patients, where tissue mass impedes sound. They exhibit a normal inspiration to expiration ratio of 3 to 1, or 4 to 1

Rhonchi - Low Pitched Wheezes

underwater sounds Low pitched wheezes (rhonchi) are continuous, both inspiratory and expiratory, low pitched adventitious lung sounds that are similar to wheezes. They often have a snoring, gurgling or rattle-like quality. Rhonchi occur in the bronchi. Sounds defined as rhonchi are heard in the chest wall where bronchi occur, not over any alveoli. Rhonchi usually clear after coughing