Post on 18-Dec-2015
What to hear ?
First Heart Sound (S1)
Closure of M + T valves.
Beginning of ventricular systole.
Second Heart Sound (S2)
Closure of A + P valves. ( A P)
End of ventricular systole.
Splitting of the S2.
Abnormalities of the Heart Sounds
1. Alteration in Intensity.2. Splitting.3. Extra Heart Sounds.4. Additional Sounds.5. Murmurs.
Abnormalities of the Heart Sounds
1. Alteration in Intensity.2. Splitting.3. Extra Heart Sounds.4. Additional Sounds.5. Murmurs.
Abnormalities of the Heart Sounds
1. Alteration in Intensity.2. Splitting.3. Extra Heart Sounds.4. Additional Sounds.5. Murmurs.
What to hear ? 3RD Heart Sound (S3)
Lubb-dupp-da Slushing in Caused by turbulent
blood flow into ventricles and detected near end of first one-third of diastole (Rapid ventricular filling).
Fluid backing up , as in cardiac failure
4TH Heart Sound (S4)Da-lubb-dupp
A stiff wall With the atria systole Non compliant
ventricles
Third Heart Sound (S3)
• Low pitched. @ apex + LLSB.• Mid-diastolic.• Triple rhythm (lub-dub-dum) (= gallop rhythm)• N: children + young people + pregnancy +
athletes + fever.• Ab. : VF, AR, MR, VSD, PDA, Constrictive
pericarditis.
Fourth Heart Sound (S4)
• High pressure atrial wave reflected back from a poorly compliant ventricle.
• Late diastolic, high-pitched sound.• NEVER physiological.• Ab. : AS, PS, MR, HTN, IHD, advanced age,
angina or MI,
Abnormalities of the Heart Sounds
1. Alteration in Intensity.2. Splitting.3. Extra Heart Sounds.4. Additional Sounds.5. Murmurs.
Pericardial friction rub
• A superficial scratching sound.• Occurs at any time during the cardiac cycle.• Sign of PERICARDITIS.• Louder with sitting up and breathing out.
Abnormalities of the Heart Sounds
1. Alteration in Intensity.2. Splitting.3. Extra Heart Sounds.4. Additional Sounds.5. Murmurs.
Murmurs
1. Timing.2. Intensity.3. Area of greatest intensity.4. Propagation.5. Effect of certain maneuvers.
Timing
• Systolic:• Innocent. (fever,
athletes, pregnancy)• Pansys. (MR, TR, VSD)• Ejection (mid) sys. (AS,
PS, ASD, severe anemia)• Late sys. (M Prolapse)
• Diastolic:• Early. (AR, PR)• Mid. (MS, TS)
• Others:• Presys. (MS, TS)• Continuous. (PDA +
fistulae)
Murmurs (cont.)
1. Timing.2. Intensity.3. Area of greatest intensity.4. Propagation.5. Effect of certain maneuvers.
Intensity
• 1/6 : soft + not heard @ first.• 2/6: soft BUT can be detected.• 3/6: moderate, NO thrill.• 4/6: loud + thrill.• 5/6: very loud.• 6/6: very, very loud (w/o stethoscope).
Murmurs (cont.)
1. Timing.2. Intensity.3. Area of greatest intensity.4. Propagation.5. Effect of certain maneuvers.
Murmurs (cont.)
1. Timing.2. Intensity.3. Area of greatest intensity.4. Propagation.5. Effect of certain maneuvers.
Murmurs (cont.)
1. Timing.2. Intensity.3. Area of greatest intensity.4. Propagation.5. Effect of certain maneuvers.
Manoeuvre Lesion
MVP AS MR
Valsalva(dec.
preload)
Longer Softer Softer
Squatting or leg raise
(inc. preload)
Shorter Louder Louder
Hand grip(inc.
afterload)
Shorter Shorter Louder