heart sound. area of auscultation pulmonary valve second intercostal space, left upper sternal...
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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