Auscultation

What is auscultation?

Auscultation (pronounced “AW-skull-TAY-shun”) is listening to the sounds of your heart, lungs, arteries and belly (abdomen). Your healthcare provider will use a stethoscope to listen to the sounds of your body. They’ll place the stethoscope directly onto your chest, neck, back and abdomen, listening for different sounds, quality, volume, timing and more.

Auscultation is a safe and easy way to diagnose potential medical conditions. It’s non-invasive and one of the oldest techniques healthcare providers use today.

When is auscultation performed?

Your healthcare provider uses auscultation during routine physical examinations. They want to check the sounds of your circulatory system, respiratory system and gastrointestinal system. They’ll use auscultation to keep an eye on your overall health, or to confirm or rule out various medical conditions.

What are the different types of auscultation?

A healthcare provider may perform auscultation near the body systems they’re listening to.

Heart auscultation

A healthcare provider will listen to the sounds your heart makes through a heart or cardiac auscultation. To do this, they’ll usually have you sit up or lie comfortably at a 45-degree angle. They may ask you to turn toward your left side or position you in another way to hear your heart clearly.

They’ll place a stethoscope on your chest to listen to your heart sounds. They’ll move the stethoscope to the five areas of your chest where they can hear your heart valve sounds the best. These heart auscultation points are all in your upper left chest area.

Your healthcare provider will listen for:

• Timing: How often your heart beats.
• Intensity: How loud your heart beats.
• Frequency: Sound waves and vibrations, also known as pitch.
• Duration: The length of your heartbeats.

Lung auscultation

Your healthcare provider will listen to the sounds your lungs make through a lung auscultation. They’ll ask you to sit upright, if possible. Your provider will place a stethoscope on your chest and ask you to take deep breaths through your mouth. Then, they’ll move the stethoscope to different pulmonary (lung) auscultation points. They’ll start at the top of your lungs and move downward, then compare the sounds of each lung.

After listening to your lungs from the front of your body, they’ll place the stethoscope on your back. Just as before, they’ll start at the top and work their way down, going from side to side. They’ll listen to one complete breath cycle at each auscultation site. After that, they’ll compare the sounds they hear between the front and back of your lungs.

Your healthcare provider will listen for:

• Duration: The length of your inhales and exhales.
• Frequency: Sound waves and vibrations, also known as pitch.
• Amplitude: The loudness or intensity in your breaths.
• Quality: Any distinctive characteristics or abnormal sounds, like wheezing.

Arteries auscultation

Your healthcare provider can also listen to arteries of your neck, abdomen and kidneys, if necessary.

Your provider will listen for:

• Bruit: A bruit is a sound that indicates turbulent (rough or uneven) blood flow in your arteries. Bruits could mean that you have poor circulation in a certain part of your body.
• Intensity: Your provider will check to see if your pulse is weak or absent. This could mean that you have a blocked artery.

Abdominal auscultation

Your healthcare provider will listen to the sounds your intestines make through abdominal auscultation. You’ll lie down comfortably on your back and prop your head up on a pillow. Your provider may put a positioner under your knees for comfort.

Your provider will place a stethoscope on your abdomen. They’ll move the stethoscope over different regions of your abdomen to listen to the sounds your bowels make.

Your healthcare provider will be listening for:

• Existence: The presence or absence of bowel sounds.
• Quantity: How frequently they can hear bowel sounds, if any.
• Quality: Any distinctive characteristics or abnormal sounds.

What do the results of auscultations mean?

Heart auscultation results

Normal heart sounds have a steady, two-beat, or “lub-dub,” rhythm to them. The first sound is called S1, or a lub. The second sound is called S2, or a dub. Your healthcare provider can hear these sounds when your heart valves are closing.

Your healthcare provider may hear various abnormal sounds in your heart, like:

• Murmurs: A heart murmur is an abnormal sound your provider may hear between heartbeats. A murmur makes a swishing sound. It happens because of turbulent or abnormal blood flow across your heart valves. There are many types of heart murmurs, and some may be a sign of a serious heart condition.
• Pericardial friction rub: A pericardial friction rub makes a high-pitched, squeaky sound. The noise sounds like two pieces of leather being rubbed together. It may point to a heart condition called pericarditis.
• Abnormal heartbeats: Abnormal heartbeats include atrial fibrillation (irregular heartbeat), tachycardia (100 beats per minute or more) and bradycardia (60 beats per minute or fewer).

Lung auscultation results

The different auscultation points of your lungs produce different normal sounds. Typically, normal lung sounds are soft and hollow. Your provider can hear them when you inhale.

Your healthcare provider may hear various abnormal sounds, including:

• Stridor: A blockage in your upper respiratory tract causes stridor. It sounds loud and high-pitched. Stridor occurs due to turbulent airflow passing through a blocked upper respiratory tract. Epiglottitis, anaphylaxis or vocal cord dysfunction may cause it.
• Wheeze: The narrowing of your airways causes wheezing. It sounds like high-pitched hissing. Wheezing may indicate that mucus is preventing your lungs from filling completely. It may be due to asthma, chronic obstructive pulmonary disease (COPD) or pulmonary edema.
• Rhonchi: Blockages in your airways cause rhonchi. It sounds like snoring. Pneumonia, COPD or cystic fibrosis may cause it.
• Crackles: Crackles are also called rales. They sound like two strands of hair rubbing together. A lung infection, such as pneumonia, or a heart condition, such as congestive heart failure, may lead to a buildup of fluid in your airway that causes crackles.
• Pleural rub: A pleural rub sounds like two pieces of sandpaper rubbing together. It might mean that tissues around your lungs are irritated. A can be a sign of pleurisy, pneumothorax or pleural effusion.
• Squawk: A squawk is also called a short wheeze or squeak. Fluctuations in your airways can cause a squawk. It sounds like a mix between wheezes and crackles. It may be a symptom of pulmonary fibrosis, bronchiolitis or pneumonia.

Abdominal auscultation results

Normal bowel sounds make a low-pitched, gurgling noise. The noise occurs every five to 10 seconds as your intestines push food through your system. This means your gastrointestinal (GI) tract is functioning properly.

Your healthcare provider will auscultate your abdomen to check for any abnormal sounds. These include:

• No sounds: If your intestines don’t make any sounds for more than two minutes, it may be a sign you have an ileus. An ileus can form when the contents of your intestines build up and the intestines temporarily stop working.
• Reduced sounds: If your bowel sounds are quieter or less frequent, it could mean that your intestinal activity is slowing or you have constipation.
• Increased sounds: Louder and more active bowel sounds may be a sign your intestinal activity is increasing or you have diarrhea.
• Grumbling or high-pitched sounds: You may have a bowel obstruction if your bowels are making grumbling sounds or high-pitched noises.

What is the triangle of auscultation?

The triangle of auscultation is a small region on your back where three back muscles meet. These muscles are the trapezius, latissimus dorsi and scapula. When you cross your arms and lean forward, these muscles thin out and the triangle of auscultation is better exposed. Your healthcare provider can hear your lung sounds more clearly when they place a stethoscope on this area.

What are the five auscultation points of the heart?

The five auscultation points of the heart are areas your provider listens to with the stethoscope that helps them assess your heart health. They’re found at certain locations on your chest that are associated with heart valves. They are:

• The aortic area. This point is between your second and third ribs on the right side of your sternum (chest bone).
• The pulmonic area. This point is in the same region as the aortic area, but on the left side.
• Erb’s point. This point is on the left side of your body, in the space in between your third and fourth ribs (providers can hear some murmurs here).
• The tricuspid area. This point is between your fourth and fifth ribs.
• The mitral area. This point is at the apex (bottom) of your heart.