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Auscultation of The Heart Dr. R. Tandon Sitaram Bhartia Institute, New Delhi
First Sound (S1) Due to closure of MV/TV Accentuated, diminished or variable intensity Wide split – Rt. BBB.
First Sound (S1) Accentuated : Loud M1 Tachycardia Short PR interval Mitral stenosis VSD, PDA. LVH Loud T1 :ASD, TAPVC Tricuspid Stenosis
First Sound (S1) Diminished :- S2 > S1 at apex. LV contractility 1° AVB AR
First Sound (S1) Variable Intensity Comp. AVB Atrial fibrillation.
Second Sound Normal :- Two components A2 & P2 A2 louder than P2 Insp.; split S2; A2-P2 Exp. : Single S2 A2 all over the precordium P2 - 2-3 ULSB
Second Sound Abnormalities : A2 or P2 Intensity:Increased or decreased Timing: Early or late
Second Sound Splitting :- Normal. W&V- PS, PAPVC - IAS, MR, VSD W&F- ASD, TAPVC, Rt. BB, WPW(A) Single-A2 or P2 or A2 + P2 Paradox-AS, PDA, LVF, Lt. BB, WPW (B)
Third Sound (S3) End of early diast. filling. Dull, 50 to 100 msec after S2. Normal in children and young adults Abnormal above 40 yrs. Left or right sided.
Fourth Sound Abnormal if audible. Rt. / Lt. sided Rt. / Lt. atrial hypertension (high RV/LV edp). Audible intermittently in comp. AVB. Acute MR - S4+.
Systolic Clicks (x) Loud sharp sounds Ejet. or Non-eject. Eject – Aortic, pulmonary – single. Non-eject - MV / TV prolapse - single or multiple.
Systolic Clicks Aortic : Constant, early Heard all over the precard Bicuspid AoV. Dilated Asc, Ao Syst. hypertension, aneurysms Fallot’s physiology, PTA. Disapear - fibrosis, calcification.
Systolic Clicks Pulmonary :- PS or PAH at ULSB. PS - Valvar PS - Audible in expirat. only - severity - closer to SI PAH- PVOD - Constant
Systolic Clicks Non-Ejection : MVPS Single or multiple. Mid systolic but can be early - radiates to base and neck Late murmur ±
S1S1 X A 2 P 2 Syst. m.
Opening Snap Mitral, diast. sound 40-120 msec after A2 A2-OS interval - severity Disappears in immobile valves Tricuspid OS drowned in MSm.
Murmur Systolic-Pansystolic. Ejection systolic Diastolic* Semilunar valves -Regurgitant m. Early diastolic m. * Atriovent. Valves -Functional m. -Obstructive m. Delayed diast. (Middiast.) Late diast. (Presyst.) Continuous
S 1 X ES. m. A2A2 AR. m.
A 2 P 2 ES. m. S 1 X PR m.
S 1 X ES. m. A 2 P 2 PR. m.
S1xS1xS2S2 S 1 x Cont. m.
Auscultation Clinical Utility :- Murmurs present. Murmurs present. Murmurs absent. Murmurs absent.
Auscultation Clinical Utility :- Murmurs absent Myocardial disease Myocardial disease - Primary – DCM, RCM, HCM - Secondary to CAD Pericardial disease Pericardial disease Utility of S3, S4, S2, S1
Auscultation Clinical Utility :- Murmurs present Cong. Ht. Dis. Cong. Ht. Dis. Rh. Ht. Dis. Rh. Ht. Dis. PMD -DCM – MR/TR PMD -DCM – MR/TR HOCM - Outflow m. -MR. m. Post M.I. - MR / VSD. Post M.I. - MR / VSD.
Heart sound. Area Of Auscultation Pulmonary valve second intercostal space, left upper sternal border Pulmonary valve Aortic valve second intercostal.
Auscultation By the time you listen, you should know what to hear If you don’t hear what you expect, explain it Don’t leave the bedside till you know.
Systolic Ejection Murmurs Chapter 14 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
Dynamic Auscultation Listening to the change in character, behaviour and the intensity of the heart sounds and murmurs to physiological and pharmacological.
HEART SOUNDS Dr. Taj There are four heart sounds SI, S2, S3 & S4. Two heart sound are audible with stethoscope S1 & S2 (Lub - Dub). S3 & S4 are not audible.
DR. MUHAMMAD SHAHID SAEED. First heart sound - M1T1 Produced by sudden closure of mitral (M) and Tricupsid (T) valve vib/sec is the frequency.
The Second Heart Sound (S 2 ) Chapter 8 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
Heart sound. 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.
1 Heart Sounds and Murmurs J.B. Handler, M.D. Physician Assistant Program University of New England.
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HEART SOUNDS By Dr. Ola Mawlana. Objectives To understand why the different heart sounds are produced. To know the sites at which heart sounds are best.
SECOND HEART SOUND Dr SHAJUDEEN.K DM Cardiology Resident Calicut Medical college.
The Cardiovascular Exam in Infants and Children Heart Rate Most labile of the vital signs Wide variations are normal Sensitive to multiple stimuli.
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Dr. R. Tandon Sitaram Bhartia Institute, New Delhi.
CARDIAC AUSCULTATION. STATION LEARNING OBJECTIVES Understand and describe the correct use of the stethoscope. Describe the normal (1st & 2nd) heart.
Cardiac Auscultation Jay L. Rubenstone, D.O., F.A.C.C. September 2007.
DR. ZAHOOR ALI SHAIKH CARDIOVASCULAR SYSTEM LECTURE - VII.
Ejection Sounds & Systolic Clicks Chapter 11 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
BLOOD PRESSURE PRACTICAL Dr. MOHAMMED SHARIQUE AHMED QUADRI ASSISTANT PROFESSOR PHYSIOLOGY ALMAAREFA COLLEGE 1.
1. CARDIOVASCULAR SYSTEM CARDIAC CYCLE HEART SOUNDS LECTURE – 4 DR. ZAHOOR ALI SHAIKH 2.
Heart sound Auscultation Stethoscopic auscultation provides the basis for identifying heart sounds, systolic and diastolic, as well as murmurs.
CONGITAL & VALVULAR HEART DISEASES Diseases Of Valves: -either stenosis or regurgitation -Congenital, Rhumatic, Degerative, Infective endocarditis,$ or.
CARDIOVASCULAR EXAMINATION I.U. Cerrahpaşa Medical Faculty Department of Pediatrics Division of Pediatric Cardiology Prof. Dr. Ayşe Güler EROĞLU.
A Technique for Cardiac Auscultation Chapter 6 Ara G. Tilkian, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
DR RAJESH K F. This is a technique of altering circulatory dynamics by means of a variety of physiological and pharmacological maneuvers and determining.
MITRAL VALVE DISEASES. MITRAL VALVE DISEASES 1. Mitral valve stenosis. 2. Mitral valve regurge. 3. Mitral valve prolapse.
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Residents Report Wednesday November 30, 2005 Jason Ryan, MD.
JAY L. RUBENSTONE, D.O., F.A.C.C. OCTOBER 2012 CARDIAC AUSCULTATION.
INTRODUCTION Heart sounds are sounds produced by the mechanical activities of the heart during each cardiac cycle. They are due to movements of Blood.
Regurgitant Systolic Murmurs Chapter 15 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
RJS Valvular heart disease Richard Schilling St Mary’s Hospital London.
The Third & Fourth (S 3 &S 4 ) Chapter 9 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
Nikhil K Chanani MD Murmurs: Do you hear what I hear? When does it matter?
Congenital heart disease (CHD) By : - Dr. Sanjeev.
Heart sound. 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.
The Cardiac Cycle Chapter 3 Ara G. Tilkian, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
Valvular Disorders By Megan Rice Annie Halverson Sara Sabelhaus Michelle Chung.
Heart Sounds Dr. Maha Alenazy. Objectives Understand types of heart sounds How to examine heart for sounds Understand murmurs Use phonocarciography Understand.
Diastolic Murmurs Chapter 16 Are G. Talking, MD, FACC Instructor Patricia L. Thomas, MBA, RCIS.
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Dr Swati Prashant MD Paediatrics Index Medical College, Indore,MP,India
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