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There are some fundamentals that continually rear their ugly head in the HESI and NCLEX review books.  Heart landmarks are one of them.  I highly suggest you memorize/understand them now and keep the information fresh in your mind.

Heart Landmarks

An easy way to memorize the pattern is by using this mnemonic: All (aortic) Pigs (pulmonic) Eat (Erb’s point) Too (tricupsid) Much (mitral).  You should learn these landmarks in your assessment class in J1 semester:

  • Aortic:  R (right) sternal border, 2nd intercostal space, the location where you can best hear the aortic valve closing (not necessarily where the aortic valve is located; important to remember that difference)
  • Pulmonic: L sternal border, 2nd intercostal space, location where you can best hear pulmonic valve closing
  • Erb’s point:  L sternal border, 3rd intercostal space, location where you can best hear the S2 sound (sound of the pulmonic & aortic valve closing)
  • Tricupsid: L sternal border, 4th intercostal space, location where you can best hear tricupsid valve closing
  • Mitral area: L midclavicular line, 5th intercostal space, location where you can best hear mitral valve closing

It’s important to not only know these landmarks but what they actually represent, which means you have to stay familiar with the anatomy of the heart.  Understand the valve placement/blood flow now; don’t put it off!

2000px-Diagram_of_the_human_heart_(cropped).svg

One last painstaking pointer, the difference between S1 and S2 heart sounds: The two major sounds of the normal heart sound like “lub dub”. The “lub” is the first heart sound, commonly termed S1, and is caused by turbulence when the mitral and tricuspid valves close at the start of systole (contraction). The second heart sound, “dub” or S2, is caused by the closure of the aortic and pulmonic valves, marking the end of systole.

I like pictures:

S1 (lub)

S1/”lub”, 1st heart sound, mitral & tricupsid valves close when heart contracts, squeezing the blood out

S2 (dub)

S2/”dub”, 2nd heart sound, pulmonic & aortic valves close, allowing blood to fill the chambers of the heart after it has contracted

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