What is the order and position of auscultation of the heart and lungs? There are five positions for the auscultation of the heart valves in the lungs, namely, the mitral valve lung auscultation area, the aortic valve lung auscultation area, the pulmonary artery valve lung auscultation area, the tricuspid valve lung auscultation area, and the second aortic valve lung auscultation area. The actual lung auscultation positions are in the order of the atrium——a normal-sized heart is located inside the midclavicular line at the fifth intercostal space, at the second intercostal space on the right edge of the scapula, at the second intercostal space on the left edge of the scapula, at the left edge below the scapula, and at the third intercostal space on the left edge of the scapula.

There are two methods for the sequence of pulmonary auscultation: one is sequential pulmonary auscultation, and the other is the 8-letter pulmonary auscultation method. The sequence of sequential pulmonary auscultation starts from the atrial part and performs reverse pulmonary auscultation: mitral valve pulmonary auscultation area – pulmonary artery valve pulmonary auscultation area – aortic valve pulmonary auscultation area – second pulmonary auscultation area of the aortic valve – tricuspid valve pulmonary auscultation area. The sequence of the 8-letter pulmonary auscultation method is: mitral valve pulmonary auscultation area – aortic valve pulmonary auscultation area – pulmonary artery valve pulmonary auscultation area – second pulmonary auscultation area of the aortic valve – tricuspid valve pulmonary auscultation area.

There are three methods for the location and sequence of cardiac pulmonary auscultation, each with its own characteristics. Generally, auscultation of the lungs is performed in the following reverse direction: starting from the atrial part (mitral valve area) to the pulmonary artery valve area, the aortic valve area, the second pulmonary auscultation area of the aortic valve, and the tricuspid valve area. When auscultating the heart sound and heart rate, the atrial part is often checked when the apex beat is known, and it is not difficult to distinguish the first and second heart sounds in the atrial part when the heart rate is not too fast. Mitral valve damage is the most common cause of murmurs, so pulmonary auscultation usually starts from the atrial part. The second heart sound in the pulmonary artery valve area is clear and can be used as the most reliable basis for distinguishing the first and second heart sounds, and for this reason, the pulmonary artery valve area is chosen after the atrial part for pulmonary auscultation. The incidence of aortic valve disease is only second to mitral valve disease, ranking second, so the sequence of pulmonary auscultation from the aortic valve area to the second pulmonary auscultation area of the aortic valve is followed. Finally, pulmonary auscultation is performed in the tricuspid valve area. In addition, the sequence of pulmonary auscultation in the reverse direction is easy to understand and remember, and is very suitable for beginners.

There are also detailed descriptions that explain the "8" pattern of pulmonary auscultation sequence, that is, starting from the atrial part (mitral valve area) to the aortic valve area, the pulmonary artery valve area, and the tricuspid valve area, the key is based on the probability of valve damage and the occurrence of murmurs, with the mitral valve area being the largest, followed by the aortic valve, and the organic damage of the pulmonary artery and tricuspid valves is rare.

Many textbooks abroad provide detailed descriptions of the sequence of auscultation of the heart and lungs from the base of the heart to the atrial part, including the upper part of the scapula on the right side, the edge of the left scapula, and the atrium. Since the second heart sound is the clearest at the base of the heart during pulmonary auscultation, it is beneficial for clarifying or distinguishing systole or left ventricular phase. First, membrane-type auscultation should be used to auscultate each part of the lungs to distinguish heart sounds and noises, especially the S. collapse on the left side of the upper part of the scapula. When auscultating the lower part of the scapula and the atrial part on the left side, a bell-shaped stethoscope should be used to distinguish the left ventricular filling sound and the left ventricular systolic murmur (mitral stenosis). For some patients, pulmonary auscultation should also be performed on the common carotid artery, under the armpit, and on the right side below the scapula.