3. Heart s ounds :• The mechanical activities of the heart during
each cardiac cycle, cause the production of
some sounds, which are called heart sounds.
Fact ors involved in t he
product ion of heart sounds
are:
• The movement of blood through chambers of
the heart.
• The movement of cardiac muscle.
8. Fi rs t heart s ound (S1):
• It is produced during isometric
contraction and earlier part of
ejection period.
• It resembles spoken word ‘LUBB’.
Characteristics:
• It is long, soft, low pitched sound.
• Duration of this sound is 0.10 –
0.17 sec
Causes:
• It mainly occurs due to sudden
closure of atrioventricular valves.
FirstheartsoundandECG:
• It coincides with peak of ‘R’ wave
of ECG
9. Abnormal S1
• Loud Fi rs t Heart Sound
– Hyperdynamic (fever, exercise)
– Mitral stenosis
– short AV intervals like Wolff-Parkinson-
White syndrome
• Sof t Fi rs t Sound
– Low cardiac output (rest, heart failure)
– Tachycardia
– Severe mitral reflux (caused by destruction of
valve)
– long PR interval
• Vari abl e I nt ens i t y of
Fi rs t Sound
– Atrial fibrillation
– Complete heart block
10. Second heart
s ound(S2):• It pro duces during the o nset o f diasto le.
• It resembles the spo ken wo rd ‘ DUBB’
Characteristics:
• It is sho rt, sharp and high pitched so und.
• Duratio n o f this so und is 0.1 0 – 0.1 4 seco nds.
Causes:
• It mainly pro duces during sudden clo sure o f the
semilunar valves.
SecondheartsoundandECG:
• It co incides with the ‘ T’ wave o f ECG.
11. AbnormalS2
• LoudSecondHeartSound(aortic)
– Systemic hypertensio n
– Dilated ao rtic ro o t
• SoftSecondHeartSound(aortic)
– Calcified ao rtic steno sis
• LoudSecondHeartSound
(pulmonary)
– Pulmo nary hypertensio n
12. Third heart sound(S3):• It isproduced during rapid filling period of thecardiac cycle.
• Heard in early diastole
• Lub-dub-by cadencesimilar to "Kentucky“ SLOSH’-ing-in
• May benormal physiological finding in patientslessthan age30.
Characteristics:
• It isshort and low pitched sound.
• Duration of thissound is0.07 – 0.10 seconds.
Causes:
• It isproduced dueto thevibrationswhich set up in ventricular wall, dueto rushing of blood in to
ventriclesduring rapid filling phase.
ThirdheartsoundandECG:
• It appearsbetween ‘T’ and ‘P’ wavesof ECG.
congestive heart failure, which is the
most common cause of a S3.
S3 is low frequency and thus
best heard with the bell of the
stethoscope at the apex while
the patient is in the left lateral
decubitus position. .
13. Fourt h heart
s ound(S4):• It is produced during atrial systole
and considered as physiologic heart
sound.
Characteristics:
• It isshort and low pitched sound.
• Duration of the sound is 0.02 –
0.04 seconds.
Causes:
• It occurs due to vibrations which
set up in atrial musculature during
atrial systole.
FourthheartsoundandECG:
• It coincides with interval between
14. Tri pl e heart
s ound:• In some conditions like myocardial
infarction and severe hypertension,
theintensity of third and fourth heart
sounds increases and they could be
heard as a single sound along with
the first and second heart sound.
Thisisknown astripleheart sound.
Importance of the heart
sounds:
• Heart sound generally alters during
cardiac diseases involving thevalves
of the heart. That’s why heart
15. Gal l op Sounds
Gallops & Other Sounds
Sound Answer
Normal
Split S1
Split S2
S3
S4
Summation Gallop
16. The
St et hos cope• The Bell
– used to hear low-pitched sounds
– used for mid-diastolic murmur of mitral
stenosisor S3 in heart failure
• The Diaphragm
– filtersout low-pitched sounds
– highlightshigh-pitched sounds
– used for analyzing thesecond heart sound,
ejection and midsystolic clicksand for the
soft but high-pitched early diastolic
murmur of aortic regurgitation
17. Pos i t i oni n
g• Patientscan beexamined whilelying
supine, in theleft lateral decubitus
position, sitting, and leaning forward.
19. Met hods t o s t udy heart
s ounds :• Therearethreemethods tostudyheartsounds:
1. By using stethoscope
2. By using microphone
3. By using phonocardiogram
Stethoscope:
• The chest piece of the stethoscope is placed over 4
areas of the chest, which are called auscultatory
areas. Theauscultatory areasareasfollow:
1. Mitralareaorbicuspidarea:
• Situated in the left V intercostal space about 3
inches from midline. This is the area of apex beat.
Mitral valvesound best heart near thisregion.
2. Tricuspidarea:
• Present over xiphoid process . Tricuspid valve
sound best heart near thisregion.
3. Pulmonaryarea:
• Present over the left II intercostal space close to the
sternum. Semilunar valve sound best heart near this
region.
4. Aortic area:
• Situated over right II intercostal space near to the
sternum. Semilunar valve sounds are best heard
near thisregion.
First heart sound is best heard in mitral and
tricuspid area where second heart sound is best
20. Referances
ht t p:/ / dept s.washingt on.edu/ physdx/ heart / t ech.ht ml
ht t p:/ / www.med.ucla.edu/ wilkes/ Syst olic.ht m
ht t p:/ / www.medst udent s.com.br/ cardio/ hear t sounds/ heart sou.ht m
ht t p:/ / www.uni-duesseldorf .de/ WWW/ MedFak/ Herz-Kreislauf -Physiologi
ht t ps:/ / en.wikipedia.org/ wiki/ Phonocardiogram
ht t p:/ / m4.wyanokecdn.com/ da17293e98727bf a9ead2837
402211d6.j pg
ht t p:/ / www.healio.com/ pediat rics/ j ournals/ pedann/ 1997-
2-26-2/ %7B4ef b230a-be51-4933-9732-
ab24a5950958%7D/ what -makes-a-heart -murmur-
innocent
ht t p:/ / radiologykey.com/ phonocardiography/ # 8760709