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Heart Sounds PDF

Heart sounds are produced by the vibration of heart valves and adjacent structures as blood flow is disrupted during cardiac cycles. The first heart sound corresponds to closure of the atrioventricular valves during ventricular contraction. The second heart sound corresponds to closure of the semilunar valves during ventricular relaxation. Additional heart sounds include S3, produced by blood oscillating in the ventricles during diastole, and S4, produced by atrial contraction forcing blood into the ventricles. Heart sounds are best auscultated using a stethoscope at various chest locations. Abnormal heart sounds called murmurs can be caused by valve stenosis or regurgitation from conditions like rheumatic fever.

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561 views

Heart Sounds PDF

Heart sounds are produced by the vibration of heart valves and adjacent structures as blood flow is disrupted during cardiac cycles. The first heart sound corresponds to closure of the atrioventricular valves during ventricular contraction. The second heart sound corresponds to closure of the semilunar valves during ventricular relaxation. Additional heart sounds include S3, produced by blood oscillating in the ventricles during diastole, and S4, produced by atrial contraction forcing blood into the ventricles. Heart sounds are best auscultated using a stethoscope at various chest locations. Abnormal heart sounds called murmurs can be caused by valve stenosis or regurgitation from conditions like rheumatic fever.

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Zennon Blaze Arceus
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© © All Rights Reserved
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You are on page 1/ 38

CLEMENT CEZAR C.

SUER, MD, DPCP

Good Day!!!

TRUE OR FALSE?
Heart sounds are produced by the
slapping together of the valve leaflets

CAUSE
vibration of the taut valves immediately
after closure, along with vibration of the
adjacent walls of the heart and major
vessels around the heart

FIRST HEART SOUND: Lub


contraction
of the ventricles

sudden backflow of
blood against the AV
valves

the back-surging blood


bounce forward again
into each respective
ventricle

AV valves close and bulge


toward the atria
until the chordae tendineae
abruptly stop the back
bulging

blood + ventricular walls+


taut valves vibrate and
causes vibrating
turbulence in the blood

vibrations travel through


the adjacent tissues to
the chest wall

SECOND HEART SOUND: Dub


Semilunar valves
close at end of
systole

Valves bulge
backward toward the
ventricles

short period of
reverberation of
blood back and forth

elastic stretch
recoils the blood
back into the
arteries

vibrations in the
arterial walls are
transmitted along
the arteries

vibrations come into


contact with the
chest wall

THIRD HEART SOUND


Blood rushing in
from the atria
during diastole

Blood oscillates
back and forth
between the walls
of the ventricles

weak, rumbling
sound heard at
the middle third of
diastole

FOURTH HEART SOUND


Atria contract
during last part
of diastole

Blood rushes
into the
ventricles

vibration

HEART SOUNDS: lub, dub


Heart Sound
first heart
sound (S1)
second heart
sound (S2)
third heart
sound (S3)
fourth heart
sound (S4)

Timing
beginning of
systole
end of systole
middle
third of diastole
diastole

Duration
0.14 sec
0.11 sec

AUSCULTATORY SITES

AUSCULTATORY SITES

Know your stethoscope!


Diaphragm
better for picking up the relatively high-pitched
sounds of S1 and S2, the murmurs of aortic
and mitral regurgitation, and pericardial
friction rubs.

Know your stethoscope!


Bell
more sensitive to the low-pitched sounds of S
and S and the murmur of mitral stenosis.
Apply the bell lightly, with just enough
pressure to produce an air seal with its full
rim.
4

Know your stethoscope!


Pressing the bell firmly on the chest makes it
function more like the diaphragm by stretching
the underlying skin.
Low-pitched sounds such as S3 and S4 may
disappear with this techniquean observation
that may help to identify them.

HEART SOUNDS: lub, dub


Heart Sound
first heart
sound (S1)
second heart
sound (S2)
third heart
sound (S3)
fourth heart
sound (S4)

Timing
beginning of
systole
end of systole
middle
third of diastole
last part of diastole

The Splitting of Heart Sounds


Why?
right ventricular and pulmonary arterial
pressures are significantly lower than
corresponding pressures on the left side
right-sided events usually occur slightly later
than those on the left

The Splitting of Heart Sounds


Instead of a single heart sound, you may hear
two discernible components, the first from leftsided aortic valve closure, or A , and the second
from right-sided closure of the pulmonic valve, or
P.
2

The Splitting of Heart Sounds


Of the two components of the S2, A2 is
normally louder, reflecting the high pressure in
the aorta. It is heard throughout the precordium.

The Splitting of Heart Sounds


P2, in contrast, is relatively soft, reflecting the
lower pressure in the pulmonary artery. It is
heard best in its own areathe 2nd and 3rd left
interspaces close to the sternum.
It is here that you should search for splitting of
the S2.

Murmurs

Abnormal heart sounds

Murmurs of Valvular Lesions


Acquired
Congenital

Murmurs of Valvular Lesions - Acquired


Rheumatic fever most common cause
group A
hemolytic
streptococci
infection

Release of
antigens

antibodies
react not only
with the
streptococcal
protein but
also to heart
valves

Scarring of
the valves

Murmurs of Valvular Lesions - Acquired


A valve in which the leaflets adhere to one another
so extensively that blood cannot flow through it
normally is said to be stenosed.

Murmurs of Valvular Lesions - Acquired


Conversely, when the valve edges are destroyed by
scar tissue that they cannot close as the ventricles
contract, regurgitation (backflow) of blood occurs
when the valve should be closed.

Murmurs of Valvular Lesions - Acquired


Stenosis usually does not occur without the
coexistence of at least some degree of
regurgitation, and vice versa.

Murmurs of Valvular Lesions - Acquired


Because the mitral valve receives more trauma
during valvular action than any of the other
valves, it is the one most often seriously
damaged, and the aortic valve is the second
most frequently damaged.
The right heart valves, the tricuspid and
pulmonary valves, are usually affected much
less severely, probably because of the lowpressure stresses that act on these valves

Systolic murmur of Aortic Stenosis


blood is ejected from the left
ventricle through only a small
fibrous opening of the aortic
valve

nozzle effect is created during


systole, with blood jetting at
tremendous velocity through
the small opening of the valve

turbulent blood causes


intense vibration, and a loud
murmur occurs during systole

Diastolic murmur of Aortic Regurgitation


blood flows backward from the
aorta into the left ventricle
during diastole

turbulence of
blood jetting backward

causing a blowing murmur of


relatively high pitch with a
swishing quality heard
maximally over the left ventricle

Systolic murmur of Mitral Regurgitation


blood flows backward through
the mitral valve into the left
atrium during systole

causes a high-frequency
blowing, swishing sound

Diastolic murmur of Mitral Regurgitation


blood passes with difficulty
through the stenosed
mitral valve from the left
atrium into the left ventricle

after partial filling, the


ventricle has stretched
enough for blood to
reverberate

low rumbling murmur


begins

Abnormal Circulatory Dynamics in Valvular Heart


Disease AR/ AS

net stroke
volume output of
the heart is
reduced

Hypertrophy of
the Left Ventricle

Eventual Failure
of the Left
Ventricle
Increase in
Blood Volume

Development of
Pulmonary
Edema

Abnormal Circulatory Dynamics in Valvular Heart


Disease MR/ MS

reduced
net
movement
of blood
from the
left atrium
into the left
ventricle

Enlarged
Left Atrium
and Atrial
Fibrillation
Development
of Pulmonary
Edema
Increase in
Blood
Volume

Circulatory Dynamics During Exercise in Patients


with Valvular Lesions
large quantities of venous blood are returned to
the heart from the peripheral circulation
Therefore, all the dynamic abnormalities that
occur in the different types of valvular heart
disease become tremendously exacerbated.

Circulatory Dynamics During Exercise in Patients


with Valvular Lesions
Even in mild valvular heart disease, in which the
symptoms may be unrecognizable at rest, severe
symptoms often develop during heavy exercise.

Circulatory Dynamics During Exercise in Patients


with Valvular Lesions
the patients cardiac reserve diminishes in
proportion to the severity of the valvular
dysfunction. That is, the cardiac output does not
increase as much as it should during exercise.

Therefore, the muscles of the body fatigue rapidly


because of too little increase in muscle blood flow.

Thank you

References
Guyton and Hall Textbook of Medical Physiology
Bates Guide to Physical Examination and History Taking

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