1. Heart sound

2. Area Of Auscultation

3. Area Of Auscultation
Pulmonary valve second intercostal space, left upper sternal border
Aortic valve second intercostal space ,right upper sternal border
Mitral valve fifth intercostal space , left midclavicular line
Tricuspid valve fourth intercostal space, lower left sternal border

4. What we hear ? LUB----------DUB
We have all heard the heart make the usual sounds.
LUB DUB
Lub is the first sound or S1
Dub is the second heart sound or S2

5. Normal heart souands
Normal

6. First heart sound S1 The “lub” in the lub – dub.
This sound is primarily because of the closing of the bicuspid and tricuspid valves.
Anatomically they are located between the atria and the ventricles
They close because the ventricles contract
The Pulmonic and Aortic valves are opening and blood is being forced into the arteries
Its maximum intensity is at the apex

7. S1 abnormalities Loud S1 Mitral stenosis
Tachycardia /hyperkinetic status
Soft S1
Mitral regurgitation
Heart failure
Obesity
Shock
Pericardial effusion

8. Second heart sound S2 This is the end of systole
S2 is the “dub” in the lub- dub
The sounds are because of the closing of the Pulmonic and Aortic valves as the pressure from the arteries is greater then the pressure in the ventricles.
This is the end of systole

9. S2 components: Has two components A2 and P2
Inspiration decreases intrathoracic pressure, increases RV filling
RV is relatively weak, and an increase in filling results in slower emptying
Inspiration delays P2, causing audible splitting of S2
P2 localized to pulmonary area while A2 audible all over the pericardium with max. intensity at aortic area

10. S2

11. S2 abnormalities Loud P2 Pulmonary hypertension Soft P2
Pulmonary stenosis
Loud A2
Systemic hypertension
Soft A2
Aortic stenosis
Aortic regurgitation

12. Split abnormalities Fixed splitting Atrial septal defect
Wide splitting
Delay pulmonic closure:
RBBB
Pulmonary hypertension
Pulmonic stenosis
Early aortic closure: MR
Fixed splitting
Atrial septal defect
Reversed splitting
Lf bundle branch block
Sever aortic stenosis

13. S2

14. Systole The time between the S1 and S2 sounds is: Lub------------Dub
The ventricles contracting
Blood flowing from the heart to the lungs and body
Blood flowing across the Pulmonic and Aortic valves

15. Diastole
The time between S2 and S1 is : Dub Lub The blood is flowing from the atria to the ventricles. The blood flowing across the bicuspid and tricuspid valves. The atrial contraction also occurs now

16. Third heart sound S3
Is a low pitched early diastolic sound best heard with the bell at the apex.
also called ventricular gallop
Occure with rapid ventricular filling after the AV valves open.
It is best heard with the bell-side of the stethoscope at the apex of the heart
Causes
Normally in Children and during pregnancy
Pathological
LVF MR

17. Fourth heart sound S4
Low pitched sound occurs at late diastole due to atrial contraction if ventricles are non complaint. Just before S1
Called a presystolic gallop or atrial gallop
It is always pathological
Causes:
Hypertension
Cardiomuopathy AS

19. Murmurs
These are abnormal sound and are longer duration s compared to heart sound produced due to the turbulence of blood flow through valves
Three Types:
Systolic murmurs
Diastolic murmurs
Continuous machinary murmur

20. Ejection systolic murmur

21. Pansystolic systolic murmur

22. Mid-Diastolic murmur

23. Early diastolic murmur

24. Continuous machinary murmur

25. Thank You