Download - Heart sound
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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