Heart soundHeart sound

What we hearWhat 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

First heart sound First heart sound S1S1

The “lub” in the lub – dub. This sound is primarily because of the

closing of the mitral and tricuspid valves.

Anatomically they are located between the atria and the ventricles

They close because the ventricles contract

S1 Louder than usual - Mitral Stenosis

Diminished Mitral or Aortic Regurg.

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. This is the end of systole

S2 Wide split sounds or fixed

Atrial Septal DefectRBBBPulmonic Stenosis

SystoleSystole

The 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

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

S3 Third heart soundS3 Third heart sound

also called a protodiastolic gallop, ventricular gallop

caused by Rapid ventricular filling. It occurs at the beginning of diastole after S2. The third heart sound is benign in youth, some

trained athletes, and sometimes in pregnancy The commonest causes are left ventricular

failure and mitral regurgitation It is best heard with the bell-side of the

stethoscope at the apex of the heart .

S4 fourth heart soundS4 fourth heart sound

called a presystolic gallop or atrial gallop. This gallop is produced by the sound of blood

being forced into a stiff/hypertrophic ventricle. It is a sign of a pathologic state, (left

ventriclular hypertrophy, hypertension, aortic stenosis)

It is best heard with the bell-side of the stethoscope at the apex of the heart .

LUB-- DUB-------------LUB—DUB S1 S2 S3 S4 S1 S2

Here is where you expect to hear the various sounds

Added soundAdded sound

Clicks

Rubs

Heart murmurs

Heart murmurs are generated by turbulent flow of blood, which may occur inside or outside the heart.

Murmurs may be physiological (benign) or pathological (abnormal).

Abnormal murmurs can be caused by stenosis restricting the opening of a heart valve, resulting in turbulence as blood flows through it.

Abnormal murmurs may also occur with valvular insufficiency (or regurgitation), which allows backflow of blood when the incompetent valve closes with only partial effectiveness.

Different murmurs are audible in different parts of the cardiac cycle, depending on the cause of the murmur

Heart murmurs are most frequently organized by timing, into systolic heart murmurs and diastolic heart murmurs.

However, continuous murmurs cannot be directly placed into either category

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