1. Heart sound

2. What we hear ? 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

3. First heart sound S1 The “ lub ” in the lub – dub. This sound is primarily because of the closing of the mitral and tricuspid valves. Anatomically they are located between the atria and the ventricles They close because the ventricles contract

4. S1 Louder than usual -  Mitral Stenosis Diminished  Mitral or Aortic Regurg.

5. Second heart sound S2 S2 is the “ dub ” in the lub- dub The sounds are because of the closing of the Pulmonic and Aortic valves. This is the end of systole

6. S2 Wide split sounds or fixed  Atrial Septal Defect RBBB Pulmonic Stenosis

7. 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

8. 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

9. Area Of Auscultation

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

11. S3 Third heart sound also called a protodiastolic gallop, ventricular gallop caused by Rapid ventricular filling. It occurs at the beginning of diastole after S2. The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy The commonest causes are left ventricular failure and mitral regurgitation It is best heard with the bell-side of the stethoscope at the apex of the heart.

12. S4 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, hypertension, aortic stenosis) It is best heard with the bell-side of the stethoscope at the apex of the heart.

13. LUB-- DUB-------------LUB — DUB S1 S2 S3 S4 S1 S2 Here is where you expect to hear the various sounds

14. Added sound Clicks Rubs

15. Heart murmurs Heart murmurs are generated by turbulent flow of blood, which may occur inside or outside the heart. Heart murmurs Murmurs may be physiological (benign) or pathological (abnormal). Abnormal murmurs can be caused by stenosis restricting the opening of a heart valve, resulting in turbulence as blood flows through it.stenosis Abnormal murmurs may also occur with valvular insufficiency (or regurgitation), which allows backflow of blood when the incompetent valve closes with only partial effectiveness. Different murmurs are audible in different parts of the cardiac cycle, depending on the cause of the murmurcardiac cycle

16. Heart murmurs are most frequently organized by timing, into systolic heart murmurs and diastolic heart murmurs.systolic heart murmursdiastolic heart murmurs However, continuous murmurs cannot be directly placed into either categorycontinuous murmurs

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