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Auscultation

What Is It, How to Perform It, and More

Author: Ashley Mauldin, MSN, APRN, FNP-BC

Editors: Alyssa Haag, Kelsey LaFayette, DNP, FNP

Illustrator: Jillian Dunbar

Copyeditor: David G. Walker


What is auscultation?

Auscultation refers to the technique performed by a variety of healthcare professionals (e.g., medical doctors and registered nurses) during a physical examination in order to listen to the internal sounds of the body, such as the heart sounds, lung sounds, and bowel sounds.

Illustration of a rib cage with each point of auscultation identified according to intercostal space.

How do you perform auscultation?

Auscultation is performed by placing a stethoscope, or a medical instrument used for listening to the internal sounds of the body, flat on the body at different locations that correspond to different organs in the body. Auscultation is usually performed in a quiet, warm, private environment. While the individual takes a deep breath, the healthcare professional will listen to the heart, lung, and bowel sounds on both the anterior and posterior (i.e., the front and back, respectively) sides of the chest as well as the anterior side of the abdomen. 

A stethoscope has two sides, a bell and a diaphragm. The diaphragm of the stethoscope is the larger flat side and is typically used to hear normal high pitched sounds that can occur in the heart, lungs, and abdomen as well as abnormal sounds that can occur (e.g., splitting of s2 in the heart, crackles in the lungs, or hypoactive sounds in the bowels). 

On the other hand, the bell of the stethoscope is the cone shaped side of the stethoscope and is usually used to hear low pitched sounds, like that of heart murmurs, which are extra heart sounds that can occur with heart failure, as well as the sound of turbulent blood flowing, also known as a bruit. 

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What are the 5 points of auscultation of the heart?

The 5 points of auscultation of the heart include the aortic, pulmonic, tricuspid, and mitral valve as well as an area called Erb’s point, where S2 is best heard. The five points of auscultation of the heart center around the heart valves and allow the listener to hear detailed mechanics of each heart valve. To listen to the aortic area, 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). The pulmonic area is located on the left side of the sternum at the 2nd intercostal space and Erb’s point is located on the left side at the 3rd intercostal space (i.e., the space between the third and fourth ribs). To listen to the tricuspid area, 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, to listen to the mitral area of the heart, the stethoscope is placed at the apex of the heart, or the area 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.

What are the auscultation points of the lungs?

The auscultation points of the lungs coincide with the type of breath sounds heard and include the area around the trachea, the area between the 1st and 2nd intercostal space on both the anterior and posterior sides of the chest, and each lateral lung field. The healthcare provider auscultating the lungs will listen for a full cycle of inspiration and expiration (i.e., inhalation and exhalation) using a stepladder pattern, or listening to the same location on both the right and left side before changing location of auscultation. This stepladder pattern allows the listener to compare the different sides of the lungs, as well as the different lobes. While auscultating, the healthcare provider will listen for both normal and abnormal breath sounds. 

Normal breath sounds include bronchial, bronchovesicular, and vesicular lung sounds. Bronchial breath sounds are loud, high pitched sounds that are heard best over the trachea on the anterior portion of the chest and below the back of the neck on the posterior side of the chest. These sounds occur as air moves through the trachea. 

Bronchovesicular breath sounds are medium pitched sounds. They are heard best over the 1st and 2nd intercostal space beside the sternum on the anterior side of the chest and between the shoulder blades on the posterior chest. These sounds are produced when air moves through the large airways of the lungs. 

Vesicular breath sounds are soft, low pitched sounds which are best heard over the entirety of the lung fields, which includes the top, middle, and bottom section of both lungs. These sounds are produced by air moving through the smaller airways in the lungs. 

Abnormal lung sounds can include diminished lung sounds and adventitious breath sounds (e.g., rhonchi, crackles, wheezes, and rales), which can be caused by various conditions, including bronchitis, asthma, heart failure, or pneumonia

What are the most important facts to know about auscultation?

Auscultation refers to the technique performed by a variety of healthcare professionals (e.g., medical doctors and registered nurses) during a physical examination in order to listen to the internal sounds of the body, such as the heart sounds, lung sounds, and bowel sounds. Auscultation is performed by placing a stethoscope, or a medical instrument used for listening to the internal sounds of the body, flat on the body at different locations that correspond to different organs in the body. The diaphragm of the stethoscope is the larger flat side and is typically used to hear normal high pitched sounds, and the bell of the stethoscope is the cone shaped side of the stethoscope, which is usually used to hear low pitched sounds. The 5 points of auscultation of the heart center around the heart valves and include the aortic, pulmonic, tricuspid, and mitral valve as well as an area called Erb’s point. The auscultation points of the lungs coincide with the type of breath sounds heard and include the area around the trachea, the area between the 1st and 2nd intercostal space on both the anterior and posterior sides of the chest, and bilaterally over the entire lung fields. The healthcare provider auscultating will listen for a full cycle of inspiration and expiration at each site using a stepladder pattern, listening for both normal and abnormal breath sounds.

Mo with coat and stethoscope

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Related links

Introduction to the cardiovascular system
Normal heart sounds
Anatomy of the lungs and the tracheobronchial tree

Resources for research and reference

Auscultation. In Medlineplus medical encyclopedia. Retrieved July 01, 2021, from https://medlineplus.gov/ency/article/002226.htm

Auscultation. In Mount Sinai. Retrieved July 01, 2021, from https://www.mountsinai.org/health-library/special-topic/auscultation

Bickley, L. S., & Szilagyi, P. G. (2017). Bates' guide to physical examination and history taking. Philadelphia: Lippincott Williams & Wilkins.

Sarkar, M., Madabhavi, I., Niranjan, N., & Dogra, M. (2015). Auscultation of the respiratory system. Annals of thoracic medicine, 10(3), 158–168. DOI: 10.4103/1817-1737.160831

Treas, L. S., Wilkinson, J. M., & 1946-, W. J. (2014). Basic nursing: Concepts, skills, & reasoning. Philadelphia, Penn.: F.A. Davis Company.