Heart Sounds

For class I made this

1. Kazan State
Medical
UniversityPhysiology Project
Heart Sounds

2. Heart Sounds

3. Heart sounds:
•The mechanical activities of the heart during
each cardiac cycle, cause the production of
some sounds, which are called heart sounds.
Factors involved in the
production of heart sounds
are:
•The movement of blood through chambers of
the heart.
•The movement of cardiac muscle.
•The movement of valves of the heart.

4. Cardiac Cycle

6. Systolic vs.
Diastolic
systole
S1 S2
diastole

7. Gallops
systole
S1 S2
S4 S3
diastole

8. First heart sound (S1):
•It is produced during isometric
contraction and earlier part of
ejection period.
•It resembles spoken word ‘LUBB’.
Characteristics:
•It is long, soft, low pitched sound.
•Duration of this sound is 0.10 –
0.17 sec
Causes:
•It mainly occurs due to sudden
closure of atrioventricular valves.
First heart sound and ECG:
•It coincides with peak of ‘R’ wave
of ECG

9. Abnormal S1
•Loud First Heart Sound
–Hyperdynamic (fever, exercise)
–Mitral stenosis
–short AV intervals like Wolff-Parkinson-
White syndrome
•Soft First Sound
–Low cardiac output (rest, heart failure)
–Tachycardia
–Severe mitral reflux (caused by destruction of
valve)
–long PR interval
•Variable Intensity of
First Sound
–Atrial fibrillation
–Complete heart block

10. Second heart
sound(S2):•It produces during the onset of diastole.
•It resembles the spoken word ‘DUBB’
Characteristics:
•It is short, sharp and high pitched sound.
•Duration of this sound is 0.10 – 0.14 seconds.
Causes:
•It mainly produces during sudden closure of the
semilunar valves.
Second heart sound and ECG:
•It coincides with the ‘T’ wave of ECG.

11. Abnormal S2
•Loud Second Heart Sound (aortic)
–Systemic hypertension
–Dilated aortic root
•Soft Second Heart Sound (aortic)
–Calcified aortic stenosis
•Loud Second Heart Sound
(pulmonary)
–Pulmonary hypertension

12. Third heart sound(S3):
•It is produced during rapid filling period of the cardiac cycle.
•Heard in early diastole
•Lub-dub-by cadence similar to "Kentucky“ SLOSH’-ing-in
•May be normal physiological finding in patients less than age 30.
Characteristics:
•It is short and low pitched sound.
•Duration of this sound is 0.07 – 0.10 seconds.
Causes:
•It is produced due to the vibrations which set up in ventricular wall, due to rushing of blood in to
ventricles during rapid filling phase.
Third heart sound and ECG:
•It appears between ‘T’ and ‘P’ waves of ECG.
congestive heart failure, which is the
most common cause of a S3.
S3 is low frequency and thus
best heard with the bell of the
stethoscope at the apex while
the patient is in the left lateral
decubitus position. .

13. Fourth heart
sound(S4):
•It is produced during atrial systole
and considered as physiologic heart
sound.
Characteristics:
•It is short and low pitched sound.
•Duration of the sound is 0.02 –
0.04 seconds.
Causes:
•It occurs due to vibrations which
set up in atrial musculature during
atrial systole.
Fourth heart sound and ECG:
•It coincides with interval between
end of ‘P’ wave and onset of ‘Q’
wave in ECG.

14. Triple heart
sound:
•In some conditions like myocardial
infarction and severe hypertension,
the intensity of third and fourth heart
sounds increases and they could be
heard as a single sound along with
the first and second heart sound.
This is known as triple heart sound.
Importance of the heart
sounds:
•Heart sound generally alters during
cardiac diseases involving the valves
of the heart. That’s why heart
sounds are having important
diagnostic value.

15. Gallop Sounds
Gallops & Other Sounds
Sound Answer
Normal
Split S1
Split S2
S3
S4
Summation Gallop

16. The
Stethoscope
•The Bell
–used to hear low-pitched sounds
–used for mid-diastolic murmur of mitral
stenosis or S3 in heart failure
•The Diaphragm
–filters out low-pitched sounds
–highlights high-pitched sounds
–used for analyzing the second heart sound,
ejection and midsystolic clicks and for the
soft but high-pitched early diastolic
murmur of aortic regurgitation

17. Positionin
g
•Patients can be examined while lying
supine, in the left lateral decubitus
position, sitting, and leaning forward.

18. Listening
Posts

19. Methods to study heart
sounds:
•There are three methods to study heart sounds:
1.By using stethoscope
2.By using microphone
3.By using phonocardiogram
Stethoscope:
•The chest piece of the stethoscope is placed over 4
areas of the chest, which are called auscultatory
areas. The auscultatory areas are as follow:
1.Mitral area or bicuspid area:
•Situated in the left V intercostal space about 3
inches from midline. This is the area of apex beat.
Mitral valve sound best heart near this region.
2.Tricuspid area:
•Present over xiphoid process . Tricuspid valve
sound best heart near this region.
3.Pulmonary area:
•Present over the left II intercostal space close to the
sternum. Semilunar valve sound best heart near this
region.
4.Aortic area:
•Situated over right II intercostal space near to the
sternum. Semilunar valve sounds are best heard
near this region.
First heart sound is best heard in mitral and
tricuspid area where second heart sound is best
heard in pulmonary and aortic areas.

20. Referances
http://depts.washington.edu/physdx/heart/tech.html
http://www.med.ucla.edu/wilkes/Systolic.htm
http://www.medstudents.com.br/cardio/heartsounds/heartsou.htm
http://www.uni-duesseldorf.de/WWW/MedFak/Herz-Kreislauf-Physiologie/lehre/sounds/intro.htm
https://en.wikipedia.org/wiki/Phonocardiogram
http://m4.wyanokecdn.com/da17293e98727bfa9ead2837
402211d6.jpg
http://www.healio.com/pediatrics/journals/pedann/1997-
2-26-2/%7B4efb230a-be51-4933-9732-
ab24a5950958%7D/what-makes-a-heart-murmur-
innocent
http://radiologykey.com/phonocardiography/#8760709
https://www.researchgate.net/figure/50214693_fig1_Fig
-1-Digital-phonocardiogram-dPCG-of-a-healthy-Beagle-
with-simultaneous

21. Thank you Very
much