Heart Sounds - Summary Medicine PDF

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Summary

Summary of heart sounds ...

Description

Sites of auscultation

Aortic valve Right 2nd intercostal space, at upper sternal border Pulmonary valve Left 2nd intercostal space, at upper sternal border Tricuspid valve Left 4th intercostal space, at lower left sternal border Mitral valve Left 5th intercostal space, just medial to mid-clavicular line th Apex beat: normal 5 ICS, mid-clavicular line HEART SOUNDS

S1 (first heart sound) caused by closure of mitral & tricuspid valves  

Soft is long PR or mitral regurgitation Loud in mitral stenosis

S2 (second heart sound) caused by closure of aortic & pulmonary valves

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 Soft in aortic stenosis Splitting during inspiration is normal – as pulmonary being behind aortic component

S3 caused by early diastolic passive filling of ventricle     

Low pitched, best heard with bell of stethoscope May occur just after S2 Normal if 30years old (may persist in women up to 50 years old) Loud S3 occurs in dilated left ventricle with rapid ventricular filling (mitral regurgitation, Ventricular Septal Defect) or poor left ventricular function (post-MI, dilated cardiomyopathy) Early & more high-pitched S3 occurs in constrictive pericarditis or restrictive cardiomyopathy

S4 caused by (forceful) atrial contraction against an active filling of stiff ventricle – always abnormal, occurs in late diastole  

May be heard in aortic stenosis, hypertrophic cardiomyopathy, hypertension In hypertrophic cardiomyopathy, a double apical impulse may be felt as a result of a palpable S4

CHARACTER & TIMING Ejection-systolic murmur (ESM)  

Usually originates from outflow tract May be innocent, common in children & high output states e.g. tachycardia, pregnancy

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Also, caused by aortic stenosis and sclerosis, pulmonary stenosis

Pan-systolic murmur (PSM)  

Uniform intensity and merges with S2 Occurs in mitral or tricuspid regurgitation, ventricular septal defect

Early diastolic murmur (EDM)  

High-pitched and easily missed (listen for ‘absence of silence’ in early diastole) Occurs in aortic regurgitation - early decrescendo murmur (and pulmonary regurgitation but rare)

Mid-diastolic murmur (MDM)  

Low pitched and rumbling Occur in mitral stenosis, rheumatic fever and aortic regurgitation

*Mitral murmurs loudest over apex *ESM of aortic stenosis radiates to carotids *PSM of mitral regurgitation radiates to axilla Accentuating Manoeuvres Px should lean forward and exhale for aortic regurgitation. Px should turn over to their left side for mitral stenosis. Expiration increases blood flow to left side of heart, so accentuates left-sided murmurs (vice versa for inspiration) Pericardial friction rub may be heard in pericarditis and is a superficial scratching sound, not confined to systole or diastole....