Heart sound Heart sound

Area Of AuscultationArea Of Auscultation

Area Of AuscultationArea 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

What we hear ?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

Normal Normal heart souandsNormal heart souands

First heart sound First heart sound S1S1The “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

S1 abnormalitiesS1 abnormalities

Loud S1

Mitral stenosisTachycardia

/hyperkinetic status

Soft S1

Mitral regurgitation

Heart failureObesityShock Pericardial

effusion

Second heart sound S2Second 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

S2 components:S2 components:Has two components A2 and P2Inspiration decreases intrathoracic

pressure, increases RV fillingRV is relatively weak, and an increase in

filling results in slower emptying Inspiration delays P2, causing audible splitting of

S2P2 localized to pulmonary area while A2 audible

all over the pericardium with max. intensity at aortic area

S2S2

S2 abnormalitiesS2 abnormalities

Loud P2Pulmonary

hypertension

Soft P2 Pulmonary stenosis

Loud A2Systemic

hypertension

Soft A2Aortic stenosisAortic regurgitation

Split abnormalitiesSplit abnormalitiesFixed splittingAtrial septal defect

Reversed splitting

Lf bundle branch block

Sever aortic stenosis

Wide splittingDelay pulmonic

closure:RBBBPulmonary

hypertensionPulmonic stenosisEarly aortic closure:MR

S2S2

SystoleSystoleThe time between the S1 and S2

sounds is:Lub------------Dub

The ventricles contractingBlood flowing from the heart to the

lungs and bodyBlood flowing across the Pulmonic

and Aortic valves

DiastoleDiastole

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

Third heart sound S3Third heart sound S3 Is a low pitched early diastolic sound best

heard with the bell at the apex. also called ventricular gallop Occure with rapid ventricular filling after

the AV valves open. It is best heard with the bell-side of the

stethoscope at the apex of the heart Causes Normally in Children and during

pregnancyPathological

LVF MR

Fourth heart sound S4Fourth 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

Murmurs 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

Ejection systolic murmurEjection systolic murmur

Pansystolic systolic Pansystolic systolic murmurmurmur

Mid-Diastolic murmurMid-Diastolic murmur

Early diastolic murmurEarly diastolic murmur

Continuous machinary Continuous machinary murmurmurmur