Chapter 96

96. How Do You Perform Auscultation? (2)

Let’s structure the problem.

What exactly is the issue we need to solve?

Apart from me and Istina, there’s literally no one in this world who knows how to do proper auscultation. Honestly, you can’t really learn much just by pressing your ear against someone’s chest or back.

Wouldn’t it just end with “Oh, I hear a heartbeat!” followed by some awe and then nothing else? That’s why figuring out *how* to perform auscultation properly is crucial. Listening alone isn’t enough.

You need an actual stethoscope, a set of rules, a sequence, and background knowledge for it to make any sense.

“Istina, do you understand what I mean?”

“Yes.”

I tapped my pen on a piece of paper, hesitating.

“We should probably create a handbook… but that sounds like such a hassle.”

“It won’t take too long, though!”

True, the bigger issue isn’t just time—it’s resources. Right now, I don’t even have enough stethoscopes for everyone. Ideally, I’d want every student attending lectures to get one so they could practice, but…

It doesn’t look feasible at the moment.

I currently only have two stethoscopes: one I made for use in the Imperial Palace and another I gave to Istina.

“Do you still have the stethoscope I gave you?”

“Yes.”

Istina nodded.

“How long would it take to make more?”

“Well, a few weeks at least… if we’re talking about dozens or even hundreds.”

Originally, I planned to ask Istina to handle it, but she somehow managed to wriggle out of it like a ninja scaling a wall. Guess I’ll have to find someone else.

If we want to distribute stethoscopes among hospital staff, it’ll definitely take some time.

For now, I’ll proceed with the next lecture as planned and distribute stethoscopes as soon as they’re ready. Only then will others be able to engage in meaningful discussions and collaborations.

“Did you hear that heartbeat? Did you measure blood pressure?”

Back in my previous life, these were things I didn’t even need to explicitly ask about. Now, though, I’m teaching everything from scratch.

“Are you prepared for the lecture?”

“Yes, I’ve worked hard on it.”

At least we’ve made progress—like developing ways to measure blood pressure and methods for producing important antibiotics.

Teaching auscultation and distributing stethoscopes will come next. We’ll build on this together since there are people willing to help.

***

Today, the lecture hall was unusually peaceful. There were a few graduate students and professors lurking around to observe, but not many.

Sitting in the front row was a graduate student named Anne.

As soon as I stepped onto the podium, I began speaking.

“So, today we’ll dive deep into the art of auscultation—listening to the internal sounds of the body.”

I scanned the room.

“What organs inside the body produce audible sounds?”

A hand shot up. It belonged to a student I hadn’t seen in a while. He must’ve moved closer to the front recently.

“Your name?”

“Lewis.”

“Good. What organs can we listen to?”

“The heart is probably the most important.”

Correct.

“You’re right. The heart produces the loudest sound since it beats continuously, making it easy to hear.”

I roughly sketched a human torso on the board and marked five points.

“Now, does anyone know how many key structures are inside the heart?”

The heart has several critical components, divided into four chambers, each with its own valve. Lewis glanced around before raising his hand again.

“There are four. The heart is divided into four sections.”

“That’s correct.”

I turned to Istina.

“So, how many points should we focus on when performing cardiac auscultation?”

“Five.”

“Exactly, including the center of the heart.”

The aortic valve regurgitation is best heard at Erb’s point, though I’m not entirely sure why. Is there a reason why aortic valve regurgitation and stenosis are heard at different points?

Anyway…

Next question.

“Istina, why does the heart produce sound?”

“Because it beats.”

“True, but why does it produce the ‘thump-thump’ sound we hear? Any guesses?”

No one responded.

“It’s the sound of the valves closing. The heartbeat you hear is actually caused by the heart valves snapping shut.”

Few people realize that the thumping sound comes specifically from the closing of the valves.

I pulled out a preserved heart, already dissected for demonstration. Holding it up so everyone could see, I explained:

“If you listen closely to the heartbeat, it follows a rhythm: ‘duh-dum, duh-dum.’ The first sound is the mitral and tricuspid valves closing simultaneously, while the second sound is the aortic and pulmonary valves closing.”

I decided to draw a diagram of the heart on the board, splitting it into four chambers.

“So, the first ‘thump’ occurs when the ventricles contract, pushing blood out to the body, causing the mitral and tricuspid valves to close.”

I drew arrows indicating blood flow toward the aorta and pulmonary artery.

“This marks the first heart sound.”

“And the second ‘thump’ happens when the atria contract, filling the ventricles with blood, causing the aortic and pulmonary valves to close. Clear so far?”

Blank stares greeted me.

“To summarize: when a living person’s heart beats, the first ‘thump’ represents blood leaving the ventricles to circulate through the body, while the second ‘thump’ represents blood entering the ventricles.”

When all else fails, call on Istina.

“Istina, do you understand what the sounds mean?”

“Uh, yes.”

Not the most confident response, but Istina is sharp. Plus, she already owns her own stethoscope.

“So, the conclusion is this: by simply listening carefully to a patient’s heartbeat, we can pinpoint which part of the heart might be malfunctioning.”

I turned to Oliver.

“Oliver, did you follow that?”

“Yes.”

“Alright…”

“Yes.”

“So, if you hear abnormal sounds immediately after the first heart sound, it indicates regurgitation in either the mitral or tricuspid valve. Based on the location where you hear the sound, you can determine whether the issue lies with the mitral or tricuspid valve, correct?”

Oliver furrowed his brow, clearly confused.

“Don’t worry—I’ll distribute booklets later. If you didn’t fully grasp it now, that’s okay.”

The classroom buzzed with murmurs. Thankfully, cardiac auscultation involves complex background knowledge, whereas lung sounds are much easier to understand.

Only Istina seemed genuinely engaged.

***

Erasing the messy heart diagram, I sketched a pair of lungs instead.

“In any case, cardiac auscultation is far more intricate, while lung auscultation is relatively simple. Amy, why is lung auscultation easier?”

“Because lungs are bigger than the heart.”

“And?”

“There are two of them.”

Exactly. I added a few lines to the lung diagram.

“Lewis, when listening to breath sounds, what should you consider first?”

“Um, breathing… speed?”

“Correct. Normal respiration occurs every 3-6 seconds. Anything outside this range suggests a problem.”

There’s one more thing.

“And as I mentioned earlier, patients have two lungs. Comparing the breath sounds between the left and right sides during auscultation gives us an advantage.”

That concludes the introduction.

Time to dive deeper into respiratory auscultation. If you’ve ever been to the hospital with a cold, you’ve likely experienced this.

“Abnormal breath sounds fall into three main categories: crackles, wheezes, and stridor. These are important.”

I wrote the three terms on the board.

“First, crackles are short, crackling sounds. They occur when the lungs fill with fluid, due to bronchitis, or fibrosis.”

“Wheezes are continuous high-pitched sounds during exhalation, caused by air passing through narrow passages. Common culprits include mucus, phlegm, or inflammation.”

This sound is often heard in asthma patients.

On a side note, crackles and wheezes frequently appear together, especially in patients with colds. Think of these as common symptoms you’ll encounter regularly.

“Stridor is a high-pitched sound during inhalation, usually indicating an obstruction in the airway.”

Many students looked puzzled. After pondering for a moment, I resumed.

“Well, breath sounds differ from heart sounds. They’re more intuitive—if you hear something unusual, it usually means there’s a problem.”

Maybe I’m overcomplicating things with jargon.

Just listen to a pneumonia patient cough. You’ll instantly recognize how sick they are.

There’s an obvious sense of danger.

***

Anne, the graduate student observing Professor Asterix’s class, scratched her head.

Is this even possible? The circulation of blood through the heart was only discovered this year and is still debated in academic circles.

And now, within days, he’s invented a device to listen to heart sounds and developed techniques to assess blood flow? Does this man even exist in the same dimension as us?

Clearly, he’s not human.

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