HEART SOUND

FATIMAH ALZAHRA’
MECHANISM OF HEART SOUND
STETHOSCOPE PLACEMENT
HEART SOUND
FIRST HEART SOUND
THE M1 PLUS AORTIC EJECTION SOUND
(SPLIT S1)
THE M1 PLUS AORTIC EJECTION SOUND
(SPLIT S1)
THE PULMONARY EJECTION SOUND
PULMONARY STENOSIS
Ejection Sound in Pulmonary Hypertension
M1 Loudness
The P–R Interval and M1 Loudness
The P–R Interval and M1 Loudness
Hemodynamic profile of Mitral Stenosis
HEART SOUND
SECOND HEART SOUND
SECOND HEART SOUND
Causes of A2 and P2 Loudness

• LOUD A2 • SOFT A2

– SYSTEMIC HYPERTENSION – CALCIFIED AORTIC STENOSIS

– DILATED AORTIC ROOT

• LOUD P2 • SOFT P2

– PULMONARY HYPERTENSION – CALCIFIED PULMONARY

STENOSIS
– ASD
– VSD
Sites of A2 and P2 Loudness
SECOND HEART SOUND
THE A2–P2 IN PULMONARY STENOSIS
SECOND HEART SOUND
The Fixed Split of S2
SECOND HEART SOUND
Paradoxical splitting in LBBB
Eliciting and Recognizing Reversed Splits
Eliciting and Recognizing Reversed Splits
EXTRA DIASTOLIC SOUND
Opening Mitral Valve
Opening Snap
EXTRA DIASTOLIC SOUND
Opening Snap
Opening Snap
Opening Snap
Opening Snap
Differentiating an A 2 –P 2 from a 2–OS

• IF THE SECOND COMPONENT OF A SPLIT S2 IS AS LOUD AT THE

APEX AS AT THE LEFT STERNAL BORDER, IT IS PROBABLY AN OS.
• IF THE SECOND COMPONENT DECREASES WITH INSPIRATION, IT
IS AN OS [IN THE ABSENCE OF LEFT BUNDLE BRANCH BLOCK
(LBBB)].
• IF THERE IS A TRIPLE SECOND SOUND AT THE LEFT STERNAL
BORDER, AN OS IS PRESENT.
• IF THE SPLIT WIDENS ON STANDING, THE SECOND COMPONENT
IS AN OS.
• IF THE S1 IS SOFT OR MUFFLED, THE SECOND COMPONENT OF
THE SPLIT S2 IS PROBABLY NOT A MITRAL OS.
EXTRA DIASTOLIC SOUND
Third Heart Sound
Third Heart Sound
Differentiating an S3 from OS

• OS IS USUALLY SHORT, SHARP CLICK, BEST HEARD WITH THE

DIAPHRAGM NEAR LEFT STERNAL BORDER. THE S3 IS A THUD OR
BOOM, BEST HEARD BY APPLYING LIGHT PRESSURE WITH THE
BELL NEAR THE APEX.
• THE OS IS ASSOCIATED WITH A SHARP, LOUD S1 . THE S3 MAY OR
MAY NOT HAVE A LOUD S1
• AN OS WILL SEPARATE FURTHER FROM THE A2 WHEN THE
PATIENT STANDS. AN S 3 WILL NOT CHANGE ITS DISTANCE FROM
THE A2 ON STANDING.
EXTRA DIASTOLIC SOUND
Fourth Heart Sound
Fourth Heart Sound

• CALLED A PRESYSTOLIC GALLOP OR ATRIAL GALLOP.

• THIS GALLOP IS PRODUCED BY THE SOUND OF BLOOD
BEING FORCED INTO A STIFF/HYPERTROPHIC VENTRICLE.
• IT IS A SIGN OF A PATHOLOGIC STATE, (LEFT
VENTRICLULAR HYPERTROPHY, HYPERTROPHIC
CARDIOMYOPATHY, MYOCARDIAL ISCHEMIA)
• IT IS BEST HEARD WITH THE BELL-SIDE OF THE
STETHOSCOPE AT THE APEX OF THE HEART, AND PATIENT
LYING IN THE LEFT LATERAL DECUBITUS POSITION
Fourth Heart Sound
Fourth Heart Sound
Fourth Heart Sound
THANK
YOU