Behind which intercostal space is the apex of the heart best auscultated?

• A. Behind the 2nd intercostal space
• B. Behind the 3rd intercostal space
• C. Behind the 6th intercostal space
• D. Behind the 5th intercostal space

Answer: (D)

The apex is the tip of the left ventricle and is located in the left chest at about the left 5th intercostal space in the midclavicular line. This is the location where the mitral valve sounds are loudest, because the heart’s tip and the mitral valve lie closest to the chest wall there. Other valve auscultation points sit in different spots (aortic area at the right or left 2nd intercostal space, pulmonic area at the left 2nd intercostal space, tricuspid area along the left lower sternal border around the 4th to 5th spaces). So, listening behind the left 5th intercostal space at the midclavicular line gives the best access to the apex and its associated mitral valve sounds.