The Standard Auscultation Positions

The four standard positions for auscultation are shown in Figure 14-31. They are as follows: Supine

Left lateral decubitus Upright

Upright, leaning forward

All precordial areas are examined while the patient is supine. Using a systematic approach, the examiner starts at either the aortic area or the apex and carefully listens to the heart sounds. After all areas are examined, the patient is then instructed to turn onto the left side. The examiner should now listen at the apex for the low-pitched diastolic murmur of mitral stenosis, which is best heard with the bell of the stethoscope. Then the patient sits upright, and all areas are examined with the diaphragm of the stethoscope. Finally, the patient sits up and

Figure 14-31 Positions for auscultation. A, The supine position, used for listening to all areas. B, The left lateral decubitus position, used for listening with the bell in the mitral area. C, The upright position, used for listening to all areas. D, The upright, leaning-forward position, used for listening with the diaphragm at the base positions.

Figure 14-31 Positions for auscultation. A, The supine position, used for listening to all areas. B, The left lateral decubitus position, used for listening with the bell in the mitral area. C, The upright position, used for listening to all areas. D, The upright, leaning-forward position, used for listening with the diaphragm at the base positions.

leans forward. The patient is asked to exhale and hold his or her breath while the examiner, using the diaphragm, listens for the high-pitched diastolic murmur of aortic regurgitation at the right and left second and third intercostal spaces.

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