Heart sound

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Heart sound
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Area Of Auscultation
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Area Of Auscultation

• Pulmonary valve second intercostal space, left
  upper sternal border
• Aortic valve second intercostal space ,right
  upper sternal border
• Mitral valve fifth intercostal space , left
  midclavicular line
• Tricuspid valve fourth intercostal space, lower
  left sternal border

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What we hear ?

• We have all heard the heart make the usual
  sounds.
• LUB----------DUB
• Lub is the first sound or S1
• Dub is the second heart sound or S2

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First heart sound S1

• The lub in the lub dub.
• This sound is primarily because of the closing of
  the bicuspid and tricuspid valves.
• Anatomically they are located between the atria
  and the ventricles
• They close because the ventricles contract
• The Pulmonic and Aortic valves are opening and
  blood is being forced into the arteries
• Its maximum intensity is at the apex

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S1 abnormalities

• Loud S1
• Mitral stenosis
• Tachycardia

• Soft S1
• Mitral regurgitation
• Heart failure

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Second heart sound S2

• S2 is the dub in the lub- dub
• The sounds are because of the closing of the
  Pulmonic and Aortic valves as the pressure from
  the arteries is greater then the pressure in the
  ventricles.
• This is the end of systole

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S2 components

• Has two components A2 and P2
• Inspiration decreases intrathoracic pressure,
  increases RV filling
• RV is relatively weak, and an increase in filling
  results in slower emptying
• Inspiration delays P2, causing audible splitting
  of S2
• P2 localized to pulmonary area while A2 audible
  all over the pericardium with max. intensity at
  aortic area

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S2 abnormalities

• Loud P2
• Pulmonary hypertension
• Soft P2
• Pulmonary stenosis

• Loud A2
• Systemic hypertension
• Soft A2
• Aortic stenosis
• Aortic regurgitation

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Split abnormalities

• Usual splitting
• normal in children and young adult
• Rt bundle branch block
• Pulmonary hypertension

• Fixed splitting
• Atrial septal defect

• Reversed splitting
• Lf bundle branch block
• Sever aortic stenosis

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Systole

• The time between the S1 and S2 sounds is
• Lub------------Dub
• The ventricles contracting
• Blood flowing from the heart to the lungs and
  body
• Blood flowing across the Pulmonic and Aortic
  valves

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Diastole

• The time between S2 and S1 is
• Dub----------Lub
• The blood is flowing from the atria to the
  ventricles.
• The blood flowing across the bicuspid and
  tricuspid valves.
• The atrial contraction also occurs now

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Third heart sound S3

• Is a low pitched early diastolic sound best heard
  with the bell at the apex.
• also called a protodiastolic gallop, ventricular
  gallop
• Coincides with rapid ventricular filling after
  the AV valves.
• It is best heard with the bell-side of the
  stethoscope at the apex of the heart
• Causes
• Normally in Children and during pregnancy
• Pathological
• LVF
• MR

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Fourth heart sound S4

• Low pitched sound occurs at late diastole due to
  atrial contraction if ventricles are non
  complaint. Just before S1
• Called a presystolic gallop or atrial gallop
• It is always pathological
• Causes
• Hypertension
• Cardiomuopathy
• AS

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Murmurs

• These are abnormal sound and are longer duration
  s compared to heart sound produced due to the
  turbulence of blood flow through valves
• Three Types
• Systolic murmurs
• Diastolic murmurs
• Continuous machinary murmur

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Ejection systolic murmur
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Pansystolic systolic murmur
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Mid-Diastolic murmur
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Early diastolic murmur
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Continuous machinary murmur
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