2. Tricuspid valve sounds typically heard in right sternal margin of 5th intercostal space Aortic valve sounds heard in 2nd intercostal space at right sternal margin Pulmonary valve sounds heard in 2nd intercostal space at left sternal margin Mitral valve sounds heard over heart apex (in 5th intercostal space) in line with middle of clavicle

3. Anatomy of the intrinsic conduction system showing the sequence of electrical excitation

4. Anatomy of the intrinsic conduction system showing the sequence of electrical excitation 1 The sinoatrial (SA) node (pacemaker) 2 The impulses pause (0.1 s) at the atrioventricular (AV) node. The atrioventricular (AV) bundle 4 The bundle branches 3 The Purkinje fibers 5

5. Sinoatrial node Atrioventricular node QRS complex P-Q Interval S-T Segment Q-T Interval

6. Sinoatrial node Atrioventricular node Atrial depolarization QRS complex Ventricular depolarization Ventricular repolarization P-Q Interval S-T Segment Q-T Interval

7. Atrioventricular valves Aortic and pulmonary valves Open Closed Open Electrocardiogram Left heart Heart sounds Ventricular volume (ml) Pressure (mm Hg) “Lup” = “Dup” = EDV = ESV = SV = Ventricular _________ Ventricular _________ Atrial _________

8. Atrioventricular valves Aortic and pulmonary valves Open Closed Open ESV Electrocardiogram Left heart P 1st2nd QRS P Heart sounds Atrial systole Dicrotic notch Left ventricle Left atrium EDV SV Aorta T Ventricular volume (ml) Pressure (mm Hg) “Lup” = closing of L AV valve or Mitral valve (1 st heart sound) “Dup” = closing of Aortic valve (2 nd heart sound) EDV = End Diastolic Volume ESV = End Systolic Volume SV = Stroke Volume Ventricular SYSTOLE Atrial SYSTOLE Ventricular DIASTOLE