Chest Auscultation Techniques

Auscultation of the chest
The following conditions and equipment will help you perform proper auscultation of the chest:

• A quiet, well-lit, warm room
• A disrobed patient. This allows you to place the stethoscope directly on the chest
• The ability to examine the patient supine, sitting and in left lateral recumbent positions (see Diagram A). You may hear different sounds, especially abnormal ones, in different positions
• The ability to examine from the patient’s right side. This helps prevent the stethoscope from being jostled or hit, which can produce extraneous sounds
• A stethoscope with both a bell and diaphragm, or the capacity to act as a bell and diaphragm. Read about our tunable diaphragm technology
• The ability to listen to one sound at a time. When listening to sounds in systole, initially ignore the sounds in diastole

Sample chest exam

At the minimum, listen to the following four areas using first the diaphragm and then the bell (see Diagram B):

1. Base Right (Aortic), the second intercostal space to the right of the sternum. You’ll hear sounds from the aortic valve best here.
2. Base Left (Pulmonic), the second intercostal space to the left of the sternum. You can hear sounds from the pulmonic valve best here.
3. Left Lateral Sternal Border (LLSB) (Tricuspid), the fourth intercostal space to the left of the sternum. You can hear tricuspid and right heart sounds best in this area.
4. Apex (Mitral), the fifth intercostal space in the midclavicular line. It’s easiest to hear mitral and left heart sounds in this area.

It’s fine to use an alternate examination sequence, as long as you auscultate the four key areas each time in a consistent manner. And make sure to assess each area for both low- and high-frequency sounds.

Find the right stethoscope for you
Ambient noise, individual hearing limitations and even the seal from the point of auscultation to your ear canal can all influence the sounds you hear. Our laboratory results do not factor in ambient noise, motion artifact or ear canal seal. Because of these variables, it’s a good idea to try different Littmann® Stethoscope models before you buy.

Left Lateral Recumbent

Sitting

Supine

Auscultation Sequence
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