1. Unit Four: The Circulation
Chapter 23: Heart Valves and Heart Sounds: Valvular and Congenital Heart Defects
Guyton and Hall, Textbook of Medical Physiology, 12 edition

2. Causes of the First and Second Heart Sounds
Duration and Pitch of the First and Second Sounds
Fig Amplitude of different frequency vibrations in the heart sounds and murmurs

3. Fourth Heart Sound (Atrial Heart Sound
Heart Sounds
Third Heart Sound
Fourth Heart Sound (Atrial Heart Sound
Chest Areas of Auscultation of Normal Heart Sounds
Fig Chest areas from which sound from each valve is best heart

4. Heart Sounds Phonocardiogram
Fig Phonocardiogram from normal and abnormal hearts

5. Heart Sounds
Valvular Lesions—resulting from rheumatic fever
Scarring of the Valves
Congenital Defects
Heart Murmurs
Systolic murmur of aortic stenosis
Diastolic murmur of aortic regurgiatation
Systolic murmur of mitral regurgitation
Diastolic murmur of mitral stenosis

6. Abnormal Circulatory Dynamics in Valvular Disease
Aortic Stenosis and Aortic Regurgitation--the net stroke
volume is reduced (stenosis: ventricle fails to empty and
in regurgitation: blood flows backward into the ventricle
Compensation by:
Hypertrophy of the left ventricle
Increase in blood volume
Eventual failure of the left ventricle and development
of pulmonary edema

7. Abnormal Circulatory Dynamics in Valvular Disease
Mitral Stenosis and Mitral
Pulmonary edema in mitral valvular disease
Enlarged left atrium and atrial fibrillation
Compensation in early mitral valvular disease
Diminished excretion of water and salt by the kidneys
Increase in blood volume
Increased venous return to the heart

8. Abnormal Circulatory Dynamics in Congenital Heart Defects
Three Major Congenital Anomalies:
Stenosis of the channel of blood flow at some point in
the heart or in a closely allied major blood vessel
An anomaly that allows blood to flow backward from
the left side of the heart or aorta to the right side or
pulmonary artery (left-to-right-shunt)
An anomaly that allows blood to flow directly from the
right side of the heart into the left side of the heart
(right-to-left-shunt)