1st heart sound

• It is produced during isometric contraction and earlier part of

ejection period.
• It resembles spoken word ‘LUB’ of "lub-dub"

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.

First heart sound and ECG:

• It coincides with peak of ‘R’ wave of ECG
 2nd heart sound
• It produces during the onset of diastole.
• It resembles the spoken word ‘DUB’ of "lub-dub"

Characteristics:
• It is short, sharp and high pitched sound.
• Duration of this sound is 0.10 – 0.14 seconds.

Causes:
• It mainly produces during sudden closure of the semilunar
valves : (aortic & pulmonary valves).

Second heart sound and ECG:

• It coincides with the ‘T’ wave of ECG.
 3rd heart sound
•It is produced during rapid filling period of the cardiac cycle.

Characteristics:
•It is short and low pitched sound.
•Duration of this sound is 0.07 – 0.10 seconds.

Causes:
•It is produced due to the vibrations which set up in ventricular wall,
due to rushing of blood in to ventricles during rapid filling phase.

Third heart sound and ECG:

•It appears between ‘T’ and ‘P’ waves of ECG.
 4th heart sound
• It is produced during atrial systole and considered as physiologic heart sound.

Characteristics:
• It is short 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.

Fourth heart sound and ECG:

• It coincides with interval between end of ‘P’ wave and onset of ‘Q’ wave in ECG.
Heart sounds & ECG

T
P

Q S
 Auscultation areas
• Auscultation means in this practical : the process of listening to the heart sound .

1- Mitral or bicuspid area :

• Situated in the left 5th intercostal space.
• This is the area of apex beat.
• Mitral valve sound best heart near this region.

2- Tricuspid area :
• Present over xiphoid process.
• Tricuspid valve sound best heart near this region.
Xiphoid process

(1st heart sound is best heard in this areas)

 Auscultation areas
3- Pulmonary area :
• Present over the left 2nd intercostal space close to the sternum.
• Semilunar valve sounds are best heard near this region.

4- Aortic area :
• Situated over right 2nd intercostal space near to the sternum.
• Semilunar valve sounds are best heard near this region.

(2nd heart sound is best heard in this areas)

Auscultation areas
The closure of the mitral and tricuspid valves at the
onset of systole. 

A. S1 Sound
B. Systole
C. Diastole
D. S2 Sound
The closure of the mitral and tricuspid valves at the
onset of systole. 

A. S1 Sound
B. Systole
C. Diastole
D. S2 Sound
Ans : A
The closure of the aortic and pulmonary valves and
heard during diastole.  
A. S2 Sound
B. S1 Sound
C. Systole
D. S4 sound
The closure of the aortic and pulmonary valves and
heard during diastole.  
A. S2 Sound
B. S1 Sound
C. Systole
D. S4 sound
Ans : A
A low frequency caused by ventricular wall
vibration when atrial blood rushes into the
ventricles in early diastole. 
A. S3 Sound
B. S2 Sound
C. S1 Sound
D. Diastole
A low frequency caused by ventricular wall
vibration when atrial blood rushes into the
ventricles in early diastole. 
A. S3 Sound
B. S2 Sound
C. S1 Sound
D. Diastole
Ans : A
A low frequency caused by atrial contraction  into
a “stiff” ventricle in late diastole
A. S4 Sound
B. S2 Sound
C. Diastole
D. S3 Sound
A low frequency caused by atrial contraction  into
a “stiff” ventricle in late diastole
A. S4 Sound
B. S2 Sound
C. Diastole
D. S3 Sound

Ans : A
When listening to heart sounds, you can best hear
S1 at the
a. base of the heart.
 b. apex of the heart.
 c. aortic area.
 d. second intercostal space to the right of the
sternum.
When listening to heart sounds, you can best hear
S1 at the
a. base of the heart.
 b. apex of the heart.
 c. aortic area.
 d. second intercostal space to the right of the
sternum.
Ans : B