Where do you Auscultate the apical pulse?

Do you know that we are only able to listen to certain sounds in the world? Humans typically are able to listen to sound with a frequency of 20 to 20 000 Hz. Sounds above or lower than this range are unable to be heard by humans as it can be either low-pitched or high-pitched. This is why certain sounds are only able to be heard by humans using devices or tools. One of them is the stethoscope. Stethoscope is used by healthcare professionals to listen to many sounds in the human body that are either high or low pitched. In this DoctorOnCall’s article, we will learn about auscultation of the apical pulse, being one of the sounds needed to be known in medical practices.

Auscultation is the method of monitoring body sounds, such as heart beats, lungs and bowel sounds, which healthcare professionals use. This is done by placing a stethoscope or a medical instrument used to listen to the internal sounds of the body on the body and placing it flat on the body, at different locations depending on what organs or body site to be examined.  Auscultation is carried out in a private and silent environment so that the best sound can be obtained.

Stethoscope is the main tool used for auscultation. This is because a stethoscope is one of the affordable tools and auscultation itself is easy to do in a daily clinical setting.  Auscultation is one of the most essential skills a healthcare professional has. Auscultation method has become one of the oldest medical techniques as it has been used for more than centuries.  Auscultation is the most reliable way to diagnose medical conditions, as it doesn’t require any external intervention. During routine physical examinations, an auscultation is usually carried out. Auscultation helps to diagnose or eliminate many suspected diseases.

Do you know that the one who invented the stethoscope is Rene Theophile Hyacinthe Laënnec? This French physician invented the stethoscope around 1816 to avoid placing an ear on a female’s patient to hear heartbeat. The first stethoscope he made was just a paper rolled into a tube and made into a funnel at the end of a hollow wooden tube. 25 years later, a stethoscope was developed with earpieces for each year. To this present day, traditional stethoscopes are a must-have tool for healthcare professionals. Modernization has enabled the development of artificial intelligence stethoscopes. This stethoscope works in ways of using a laser camera to detect heartbeat or signs of heart problems.

Auscultation we will be focusing on here is by the conventional stethoscope that you are already familiar with or at least have seen in real life. Stethoscope has two sides, a diaphragm and a bell. The diaphragm of the stethoscope is described as the larger flat side whereas the bell is the cone shaped. The diaphragm part is usually used to hear high pitched sounds, whereas the bell part is used to hear low pitched sounds. Examples of high-pitched sounds are sounds of the abdomen, heart and lungs. Examples of low-pitched sounds are extra heart sounds or heart murmur.

Methods of auscultation depend on the site where the stethoscope is placed. When we talk about apical pulse, we are talking about the heart. Apical pulse is located on the left side of the chest, typically below the nipple. Specifically, it is below the 5th intercostal space at the midclavicular line. Apical pulse is the number of heart beats in a minute measured at the specific point. Apical pulse is usually taken to determine the heart rate of a child and to check for the heart in those already with heart diseases or suspected with heart problems. Apical pulse can give clear information on the heart function. Apical pulse itself comes from the word “apex” which is the very tip of the heart. Apical pulse should not be confused with blood pressure.

When examining the apical pulse, healthcare professionals usually do heart auscultation in general which means checking the whole heart.  Auscultation of the heart starts with patients sitting or lying down with a 45 degrees angle. Sometimes it is necessary to move patients to the left side or to place them in a way that makes it easier for the heart to hear. The stethoscope is placed on the chest and moved to four or five places in order to listen for heart valves’ sounds. Doctors may also look for abnormal sounds that might be produced by the heart, in addition to the quality and amount of heartbeats. Heart auscultation is also known as cardiac auscultations.

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It can be concluded that auscultation is made possible with the presence of a stethoscope. Stethoscope is said to be one of the basic tools needed for healthcare professionals. Auscultations can give information on the organs affected. Patients might need additional medical tests if there is suspicion or possible problems that need further investigation.