Anatomy
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This was previously featured in an exam
Thorax
Question 28 of 30
You are performing a full cardiovascular examination on a patient presenting to ED with palpitations. The mitral valve is best auscultated at which of the following sites:
Answer:
The mitral valve is heard over the apex of the heart in the left fifth intercostal space at the midclavicular line.Cardiac Valves
Anatomy / Thorax / Heart and Pericardium
Last Updated: 11th April 2019
Table: Surface Marking and Auscultation Positions of the Heart Valves
| Heart valve | Surface Marking | Auscultation Position |
|---|---|---|
| Tricuspid valve | Posterior to right half of sternum at level of 4th ICS | Left of sternum near 5th ICS |
| Mitral valve | Posterior to left half of sternum at level of 4th costal cartilage | Left 5th ICS in midclavicular line |
| Pulmonary valve | Posterior to third left chondrosternal joint | Medial end of left 2nd ICS |
| Aortic valve | Posterior to left half of sternum at level of 3rd ICS | Medial end of right 2nd ICS |
Surface Markings
- The tricuspid valve is located posterior to the right half of the sternum at the level of the fourth intercostal space.
- The mitral valve is located posterior to the left half of the sternum at the level of the fourth costal cartilage.
- The pulmonary valve is located posterior to the third left chondrosternal joint.
- The aortic valve is located posterior to the left half of the sternum at the level of the third intercostal space.
Auscultation Positions
Heart valves should be auscultated by positioning the stethoscope downstream from the flow of blood through the valves.
- The tricuspid valve is heard just to the left of the lower part of the sternum near the fifth intercostal space.
- The mitral valve is heard over the apex of the heart in the left fifth intercostal space at the midclavicular line.
- The pulmonary valve is heard over the medial end of the left second intercostal space.
- The aortic valve is heard over the medial end of the right second intercostal space.
![Modified by FRCEM Success. Original by Mikael Häggström (See above. All used images are in public domain.) [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/01/Surface_anatomy_of_the_heart.png)
Surface Markings of the Heart Valves (And Auscultation Positions). (Image modified by FRCEM Success. Original by Mikael Häggström [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
