1. Heart sound

3. 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

4. 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

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

6. 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

7. 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

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

9. S2 Usual splitting normal in children and young adult Rt bundle branch block Pulmonary hypertension Fixed splitting Atrial septal defect Reversed splitting Lf bundle branch block Sever aortic stenosis

10. 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

11. 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

12. Area Of Auscultation

13. 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

14. 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.

15. 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.

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

17. Added sound Clicks Rubs

18. 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

19. 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

20. Ejection systolic murmur

21. Pansystolic systolic murmur

22. Mid-Diastolic murmur

23. Early diastolic murmur

24. Continuous machinary murmur

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