Examination of the thorax

While sitting, the lungs are also examined. To do this, the examining physician first places his hands on the sides of the ribcage and examines the movement of the ribcage (thoracic excursion). Then the physician places his hand on the burst basket and taps it with his other hand (percussion).

In this way, the knocking sound of the lungs can be examined and conclusions about ventilation can be drawn. In addition, the lung boundaries can be determined in this way. The examiner then listens to the lung with a stethoscope (auscultation).

This is done not only at the back, but also at the tips of the lungs, directly behind the collarbone and also from the front. The opportunity can also be taken to listen to the trachea. After the examination of the lungs, the patient may lie down.

It is important to ensure that the upper body is elevated at a 45° angle. This allows the filling status of the neck veins (jugular veins) to be assessed. The so-called hepato-jugular reflux test provides further information about the regular filling of the veins.

To do this, the doctor presses once deeply under the right costal arch, where the liver is located. Afterwards, the heart is monitored with a stethoscope. The test begins in the third intercostal space on the left (3rd ICR left) at the Erb point, where all valve sounds are equally loud.

In order to be able to distinguish between the first and second heartbeat, the pulse is also felt, for example, on the wrist. Then the individual heart valves are listened to. The aortic valve is monitored in the second intercostal space on the right (2nd ICR right), the pulmonary valve is monitored in the second intercostal space on the left (2nd ICR left), the mitral valve is monitored in the fifth intercostal space on the left (5th ICR left) and the tricuspid valve is monitored in the fourth intercostal space on the right (4th ICR right).

The carotid artery is also listened to for a more detailed examination. If necessary, conduction sounds may be heard here. For particularly accurate listening, the patient can be asked to bend forward so that the sounds of the aortic valve can be heard even better.To listen closely to the mitral valve, the patient should turn to his left side so that the doctor on the left side can assess the mitral valve again.

The mitral valve is located between the left atrium and the left ventricle and is open during the relaxation phase of the heart. The aortic valve is located between the left ventricle and the aorta and is open during the contraction phase of the heart. The tricuspid valve, like the mitral valve, is open during the relaxation phase and is located between the right atrium and the right ventricle. The pulmonary valve is located between the right ventricle and the pulmonary artery and is also open during the contraction phase.