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    Heart Sounds

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    Abcd
    This document discusses normal and abnormal heart sounds. It begins by describing the four normal heart sounds (S1, S2, S3, S4) and how they are produced, heard, and where they are best auscultated on the chest. It then discusses abnormalities such as split sounds, gallop rhythm, and murmurs. Murmurs are abnormal heart sounds caused by turbulent blood flow and can be systolic, diastolic, or continuous. The document concludes by describing the parts of a stethoscope and its uses for auscultating heart sounds and other body sounds.

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    Heart Sounds

    Uploaded by

    Abcd
    72 views18 pages
    This document discusses normal and abnormal heart sounds. It begins by describing the four normal heart sounds (S1, S2, S3, S4) and how they are produced, heard, and where they are best auscultated on the chest. It then discusses abnormalities such as split sounds, gallop rhythm, and murmurs. Murmurs are abnormal heart sounds caused by turbulent blood flow and can be systolic, diastolic, or continuous. The document concludes by describing the parts of a stethoscope and its uses for auscultating heart sounds and other body sounds.

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    This document discusses normal and abnormal heart sounds. It begins by describing the four normal heart sounds (S1, S2, S3, S4) and how they are produced, heard, and where they are best auscultated on the chest. It then discusses abnormalities such as split sounds, gallop rhythm, and murmurs. Murmurs are abnormal heart sounds caused by turbulent blood flow and can be systolic, diastolic, or continuous. The document concludes by describing the parts of a stethoscope and its uses for auscultating heart sounds and other body sounds.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    72 views18 pages

    Heart Sounds

    Uploaded by

    Abcd
    This document discusses normal and abnormal heart sounds. It begins by describing the four normal heart sounds (S1, S2, S3, S4) and how they are produced, heard, and where they are best auscultated on the chest. It then discusses abnormalities such as split sounds, gallop rhythm, and murmurs. Murmurs are abnormal heart sounds caused by turbulent blood flow and can be systolic, diastolic, or continuous. The document concludes by describing the parts of a stethoscope and its uses for auscultating heart sounds and other body sounds.

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    ‫ﺼﺩﻕ ﺍﷲ ﺍﻟﻌﻅﻴﻡ‬

    ‫ﺍﻻﺴﺭﺍﺀ ﺍﻴﺔ ‪58‬‬


    Heart Sounds
    Introduction

    Learning objectives:
    1.Know types of normal heart sounds.
    2.Know the abnormal heart sounds e.g. murmurs.
    3.Know the methods used to detect normal and abnormal
    heart sounds
    4.Demonstrate, on a living person , where a stethoscope
    should be placed to auscultate for heart sounds or
    murmurs
    Introduction

    Remember that:
    The classical sequence of clinical examination is;
    1.Inspection (look)
    2.Palpation (feel)
    3.Percussion (tap)
    4.Auscultation (listen)
    Normal Heart Sounds 
    Sounds

    •• There are 4 sounds produced


    by the heart that are produced
    vibrations of the cusps of the
    heart valves. 
    valves.
    •• 4 cardiac valves;
    1.2 Atrioventricular (AV)
    valves (tricuspid and mitral
    valves)
    2.2 semilunar valves (aortic and
    pulmonary valves)
    Methods of Detection of Heart Sounds
    a)Stethoscope:
    2 sounds are only audible
    by stethoscope

    b) Phonocardiograph:
    records for 4 sounds →
    phonocardiogram
    Normal Heart Sounds
    S1
    Duration 0.15 second
    Relation to •Isometric contraction phase
    cardiac cycle •Maximum ejection phase
    Causes: 3 components:
    a­Valvular component (sudden closure of AV valves)
    b­Ventricular component
    c­Vascular component:
    Characters •• Soft and low pitched (25­40 Hz) sound.
    •Heard as the word Lub by the stethoscope.
    Auscultatory a­ Mitral area (M): left 5th intercostal space at MCL
    sites b­Tricuspid area (T): left 4th intercostal space near
    sternum
    Normal Heart Sounds
    S2
    Duration 0.1 second.
    Relation to cardiac •Isometric relaxation phase
    cycle
    Causes: sudden closure of semilunar valves (aortic and
    pulmonary)
    Characters •Sharp and high pitched (50 Hz)
    •Heard as the word Dub by stethoscope.
    Auscultatory sites a­ Aortic area (A): 2nd right intercostal space near
    sternum
    b­ Pulmonary area (P): 2nd left intercostal space near
    sternum
    Normal Heart Sounds
    S3
    Duration 0.05 second
    Relation to •Terminal part of the rapid filling phase
    cardiac cycle
    Causes: It is due to vibrations of the relaxed
    ventricular wall and of the cusps of AV
    valves
    Characters •It is a low pitched sound that can
    sometimes be heard only in children.
    Auscultatory It is best heard at the mitral area, while
    sites the person is in recumbent position and
    leaning to the left side
    Normal Heart Sounds
    S4
    Duration 0.03 second.
    Relation to •mid­point of atrial systole→ presystolic
    cardiac cycle HS
    Causes: It is due to vibration of the cusps of the
    AV valves due to rush of blood from the
    atria to the ventricles
    Characters •It is a faint low pitched sound that is
    normally inaudible both in children and
    adult.
    Auscultatory If heard abnormally it is heard at the
    sites mitral area.
    Abnormalities of Heart Sounds
    1)Splitting (duplication) of HS:
    Def.,
    The HS is heard as 2 sounds separated by a very short interval.
    Causes:
    It is due to asynchronous closure of valves on both sides of the heart.
    a)Splitting of the 1st HS:
    — It is due to asynchronous closure of the mitral and tricuspid valves.
    — Closure of the TV slightly precedes the closure of the MV
    b)Splitting of the 2nd HS: 
    — It is due to asynchronous closure of the aortic and pulmonary valves.
    — The aortic valve closes slightly earlier than the pulmonary. 
    — This is observed during inspiration.
    Abnormalities of Heart Sounds
    2) Triple or gallop rhythm:
    Def.,
    It is an abnormal condition in which
    three heart sound are heard
    resembling the sound of a galloping
    horse.
    Causes and types:
    It occurs in heart failure, it is either;
    1.Protodiastolic gallop→
    gallop if the
    third heart sound is the 3rd sound.
    2.Presystolic gallop if the 4th
    gallop→
    heart sound is the 3rd sound.
    Abnormalities of Heart Sounds
    3) Murmurs:: 
    Def.,
    They are abnormal noisy sounds heard over the heart
    other than the heart sounds.
    Murmurs
    Mechanism of murmurs:
    — They are caused by change in the rate of blood flow:
    — The blood flow in vessels may be;
    i)Streamline or laminar flow: 
    — The blood flows in layers or laminae which is faster in the center
    and slow at the periphery.
    — It is silent flow i.e. produces no sound.
    ii)Turbulence flow: 
    — In which there is an eddy current, i.e. not all particles move in the
    same moment.
    — The agitation of fluid particles produces a noisy or murmur.
    Murmurs
    Types of murmurs: 
    It includes 3 types as follow;
    Systolic murmurs Diastolic murmurs Continuous murmurs
    Time  Occur  during  ventricular  systole  Occur  during  cardiac  Occur during systolic and 
    i.e. in the interval between the  1 st  diastole  i.e.  after  the  2 nd  diastolic periods 
    and 2 nd  heart sounds.  heart sound  (machinery murmur)
    Causes a­ Organic murmur: due to; a­ Narrowing or as  in  case  of  Patent 
    i) Narrowing or stenosis  of  stenosis of mitral or  ductus arteriosus which is 
    aortic or pulmonary valve. tricuspid valve.  a  duct  present  between 
    ii)Widening or regurgitation  of  b­ Widening or the  aorta  and  pulmonary 
    mitral or tricuspid valve. regurgitation of the  artery  in  foetus  and 
    iii)Congenital interventricular aortic or pulmonary valve.  closed at birth.
    septal defect (VSD)
    b­Functional murmurs: 
    Present  as  a  result  of  change  in 
    the rate  of  blood  flow  as  in  fever, 
    anemia and exercise. 
    Stethoscope

    It consists of 3 parts:
    a. Chest piece → consists of 2
    parts
    Cone of bell → for low pitched
    sounds
    Diaphragm →for high pitched
    sounds

    b. Ear pieces.

    c. Rubber tube (50­75 cm).


    Stethoscope

    Uses of stethoscope: 
    1. Auscultation of heart sounds. 
    2. Auscultation of breath sounds 
    3. Auscultation of intestinal sounds 
    4. Measurement of ABP.
    K S  
    A N
    T H

    Abdel Aziz Hussein, Mansoura University, Mansoura, Egypt

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