Heart sounds topic cardio vascular system
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Sep 25, 2024
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About This Presentation
Medical
Slide Content
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
-SaSi
A2P253
SAS
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
-SaSi
A2P253
SAS
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
-
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
-
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
e
-
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
e
-
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
So
L#2N
EXTI
Inst
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
So
L#2N
EXTI
Inst
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
Heart Sounds
Loading…
Heart sounds
➢ S1 – “lubb” caused by the closing of the AV valves
➢ S2 – “dupp” caused by the closing of semilunar valves
➢ S3 –associated with blood flowing into the ventricles
➢ S4 –associated with atrial contraction
Four heart sounds can be recorded by phonocardiography,
but normally only the first and the second heart sounds,
are audible through a stethoscope
First heart sound
• occurs when the
atrioventricular (AV) valves
close at the beginning of
ventricular contraction
• generated by the vibration of
the blood and the ventricular
wall
• is louder, longer, more in
duration than the second heart
sound
Loading…
LOUD S1
HYPERDYNAMIC STATE: (LV closes loudly)
•FEVER/SEPTIC
•THYROTOXICOSIS
•EXERCISE
•ANAEMIA
•PREGNANCY
•SHORT PR INTERVAL (EDV <, VALVES CLOSE FAST{WPW} )
•MS (MILD TO MOERATE)(LV > PRESSURE THAN RV)
LOUD S1
HYPODYNAMIC STATE: (LV closes SOFTLY)
•HEART FAILURE
•LONG PR INTERVAL (HEART BLOCKS)
•MS (SEVERE), MR (POOR CLOSURE OF LEAFLETS)
Second heart sound
• occurs when aortic and
pulmonary semilunar valves
close at the beginning of
ventricular dilation
• generated by the vibration of
the blood and the aorta
• Aortic valve closes slightly
before pulmonary valve
• Splitting of S2
LOUD S2
•HIGH PULMONARY ARTERY PRESSURE (PULMONARY HTN)
•SYSTEMIC HTN
SOFT S2
•AORTIC STENOSIS (LESS PLIABLE LEAFLETS BARELY OPENS OR CLOSES)
SPLIT S2
•DURING EXPIRATION, LESS BLOOD IN RV AND MORE IN LV →SYSTOLE →S1
•DURING INSPIRATION →↑RV BLOOD AND ↓LV BLOOD → MORE TIME BY RV
TO SYSTOLE →SO P2 LATE THAN A2 →PHYSIOLOGICAL SPLIT
WIDE SPLIT S2
INSPIRATION → →↑RV BLOOD →RV AFTERLOAD ALREADY HIGH
CAUSES- PUL. HTN, PUL. STENOSIS, DELAY OF RV DEPOLARISATION,
RAPID DEPOLARISATION OF LV (WPW-A BUNDLE OF KENT IN BET RV AND
LV)
FIXED SPLIT S2 (FIXED SPACE BET. A2 AND P2)
CAUSES- ASD (SIMILAR WHILE INS. AND EXP.)
PARADOXICAL SPLIT S2 (P2 FIRST THEN A2)
CAUSES- HIGH LV AFTERLOAD (AS,HTN, COARCTATION OF AORTA),
PROLONGED DEPOLARISATION (LBBB)/ QUICKER DEPOLARISATION OF RV
(WPW-B)
DURING EXP. WIDE PARADOXICAL SPLIT (LV >BLOOD)
ABSENT S2
CAUSES-SEVERE AS (ONLY P2 PRESENT )
S3 (1ST RAPID DIASTOLIC FILLING)
S1-S2- VENT. SYSTOLE
S2-S1- VENT. DIASTOLE
(S3 AND S4- HEARD IN DIASTOLE)
PHYSIOLOGICAL S3-
RAPID VENT. FILLING DUE TO COMPLIANT VENT.
----PREGNANCY, YOUNG ATHLETS.
PATHOLOGICAL S3-
LV DILATION- AR, MR, DOC, SYSTOLIC HF.
S3- LOW PITCH(BETTER HEARD THROUGH BELL), {ALSO BETTER HEARD IN
LEFT LAT. DECUPITUS POSITION}
Loading…
S4 (LAST RAPID FILLING/ATRIAL KICK)
WHEN VENT. ARE STIFF.(HEARD IN LATE DIASTOLE)
CAUSES- LEFT ATRIAL HYPERTROPHY (MS)
IF LV HAS ↑ EDV-(HTN, AS, HOCM)
S4- LOW PITCH, BEST IN LEFT LAT. DECUPITUS
ALWAYS PATHOLOGICAL
EXTRA SYSTOLIC HEART SOUNDS ( EJECTION CLICK )
IN PS AND AS→EJECTION CLICK DUE TO BOWING OF PVs.
HEARD DURING- IN EARLY TO MID VENT. SYSTOLE
IN MITRAL VALVE PROLAPSE- DURING TO MID SYSTOLE – DUE TO WEAK
LEAFLETS/WEAK CHORDAE TENDINAE
IN PROSTHETIC VALVE- SYSTOLIC CLICKS ARE NORMAL, NO CLICK IS
ABNORMAL.
EXTRA DIASTOLIC HEART SOUNDS(OPENING SNAPS)
IN MS, TS– FIBROTIC VALVES DONOT OPEN PROPERLY, SO DUE TO
INCREASE PRESS. OPEN WITH A SNAP, RIGHT IN BEGINNING OF
DIASTOLE.
PERICARDIAL KNOCK (IN FIBROSED PERICARDIUM)
PERICARDIAL FRICTION RUB (TRIPHASIC HEART SOUND)
Phonocardiograms examples
Thank You
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