Aortic valve auscultation area

The organic murmur caused by aortic regurgitation is mainly diagnosed in the aortic valve auscultation area. The murmur has a decreasing and soft sigh-like characteristic in the early stage, which is transmitted from the left edge of the sternum and the apex of the heart. The most common causes are rheumatic valvular heart disease or aortic regurgitation due to idiopathic aortic valve prolapse. Now let’s take a closer look at the aortic valve auscultation area.

The heart valve auscultation area is the part of the body where the sound produced by the opening and closing of the heart valves is transmitted to the body surface and is most easily heard. It is called the heart valve auscultation area, which is not completely consistent with its anatomical position.

Auscultation order: starting from the mitral valve area - pulmonary valve area - aortic valve area - the second auscultation area of ​​the aortic valve - tricuspid valve area.

composition

There are usually 5 heart valve auscultation areas:

①Mitral valve area (M): located at the strongest point of apical beat, also known as apical area;

② Pulmonary valve area (P): at the second intercostal space on the left side of the sternum;

③ Aortic valve area (A): located at the second intercostal space on the right side of the sternum;

④ The second auscultation area of ​​the aortic valve (E): at the third intercostal space on the left side of the sternum, also known as the Erb area;

⑤Tricuspid valve area (T): on the left edge of the lower end of the sternum, that is, between the 4th and 5th ribs on the left edge of the sternum.

order

The order of auscultation is as follows:

The usual order of auscultation is to start from the apex area and auscultate in a counterclockwise direction: first listen to the apex area, then the pulmonary valve area, then the aortic valve area, the second aortic valve area, and finally the tricuspid valve area. Some clinicians also auscultate each valve area in turn, starting from the base of the heart.

It should be pointed out that these common auscultation areas are set under the assumption that the heart structure and position are normal. When the heart structure and position of heart disease change, it is necessary to appropriately move the auscultation site and expand the auscultation range according to the characteristics of the heart structure change and the direction of blood flow. For some heart diseases with abnormal heart structure, specific auscultation areas may be used.

When the ventricles contract, blood rushes upward, pushing the aortic valve leaflets away from the center of the aortic cavity; when the ventricles relax, the valve leaflets passively descend into the center of the aortic cavity. When the valve morphology is normal, the three leaflets coapt along the commissure edge and support the blood column in the aorta to prevent it from flowing back into the ventricle. Two of the three aortic sinuses give rise to the coronary arteries and are therefore named the left, right, and noncoronary sinuses. By studying the attachment edges of each leaflet, we can clearly understand the relationship between the aortic valve and the surrounding structures. Starting from the back, the junction between the noncoronary and left coronary valves is located as the area of ​​aortic-mitral continuation. The subaortic fibrous drape is located below the commissure. To the right of this junction, the noncoronary valve attaches to the superior aspect of the posterior left ventricular outflow tract diverticulum.