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Dr.Vitrag Shah
First year resident,MD Medicine
April-2012
GMC,Surat
Dr.Vitrag Shah - www.medicalgeek.com
Dr.Vitrag Shah - www.medicalgeek.com
Dr.Vitrag Shah - www.medicalgeek.com
Different areas for auscultation of heart
Content of auscultation
1. Heart rate
2. Heart rhythm
3. Heart sound
4. Heart murmurs
Normal heart valves make a sound when they close but not when
they open. The classic 'lub-dub' sounds are caused by closure of
the atrioventricular (mitral and tricuspid) valves followed by the
outlet (aortic and pulmonary) valves.
Components of S1
Loud
Increased cardiac output
Large stroke volume
Mitral stenosis
Short P-R interval
Atrial myxoma (rare)
Variable
Atrial fibrillation
Extrasystoles
Complete heart blockDr.Vitrag Shah - www.medicalgeek.com
S1
Wide Splitting
RBBB
PVC from Left Ventricle
Single Sound
Normal
LBBB
PVC from Right Ventricle
Paced Beats
Click
High Frequency Sound Found in Mitral Valve
Prolapse
Occurs Earlier with Valsalva Maneuver or
Squatting to Standing
Systolic Murmurs
Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
Tricuspid insufficiency
Diastolic Murmurs
Aortic insufficiency
Mitral stenosis
S1 S2 S1
Dr.Vitrag Shah - www.medicalgeek.com
Describing a heart murmur
1. Timing
murmurs are longer than heart sounds
HS can distinguished by simultaneous palpation of the
carotid arterial pulse
systolic, diastolic, continuous
2. Shape
crescendo (grows louder), decrescendo, crescendo-
decrescendo, plateau
3. Location of maximum intensity
is determined by the site where the murmur originates
e.g. A, P, T, M listening areas
Still’s Murmur
○ Medium Frequency, Vibratory, Originating from
Leaflets of Pulmonic Valve
Dr.Vitrag Shah - www.medicalgeek.com
Innocent or Normal Murmurs-
Continuous
Venous Hum
Continuous Mammary Soufflé
Isometric Exercise