APE To Man

APE to Man is a mnemonic that assists a clinician in remembering where to place the stethoscope in order to listen for heart sounds during a physical examination. Heart sounds occur from the closing of heart valves, just like a door slamming shut, and the sound is transmitted in the direction of blood flow. There are four valves in the heart: two atrioventricular (AV) valves and two semilunar valves. The two atrioventricular valves separate the atria from the ventricles and include the tricuspid valve on the right side and the mitral valve (i.e. bicuspid valve) on the left side. The two semilunar valves separate the ventricles from the large arteries (i.e. the pulmonary artery and the aorta) and include the aortic valve on the left side and the pulmonary valve on the right side. In the mnemonic APE To Man, the first initials of the heart valves are listed in the order they are heard during auscultation as the stethoscope moves from the top right to the bottom left of the chest wall. 

Of note, there are other mnemonics, such as Try Pulling My Aorta where "T" stands for tricuspid, "P" stands for pulmonary, "M" stands for Mitral, and "A" stands for aortic, that can assist in remembering the the anatomical positions of the heart valves and the order in which blood flows through the heart. 

The "APE" in APE To Man stands for aortic and pulmonary valves as well as for an area called Erb’s point where S2 (a sound produced by the closure of both the aortic and pulmonary valves) is best heard. To listen to the closing of the aortic valve, the stethoscope is placed on the right side of the sternum (i.e. the breastbone located in middle of the chest) at the 2nd intercostal space (i.e. the space between the second and third ribs). To listen to the pulmonic valve closing, the stethoscope should be placed on the left side of the sternum at the 2nd intercostal space. Erb’s point is located on the left side at the 3rd intercostal space (i.e. the space between the third and fourth ribs).

The "To" in APE To Man stands for the tricuspid valve, and to listen to the tricuspid valve, the stethoscope is placed on the lower left sternal border at the 4th intercostal space (i.e. the space between the fourth and fifth ribs). 

Lastly, "Man" in APE To Man is for mitral valve, and to listen to the mitral valve, the stethoscope is placed at the apex of the heart, which is located on the  left side of the sternum at the 5th intercostal space (i.e. the space between the fifth and sixth ribs) on the midclavicular line (an imaginary, vertical line that passes through the midpoint of the clavicle). In individuals with breasts, this space might be covered with breast tissue, and thus, the clinician should request that the individual lifts the breast tissue to allow for proper auscultation. 

The mnemonic "APE To Man" represents the points of auscultation of the heart in order to listen to the heart sounds produced when valves are closing. The "APE" stands for aortic and pulmonary valves as well as for Erb’s point. The "To" stands for tricuspid valve, and lastly, "Man" stands for mitral valve.