Heart sounds

noise generated by the pulsate heart

Emily’s racing heartbeat (




Reading: Heart sounds

) Heart sounds of a 16 year previous girl immediately after running, with a affection rate of 186 BPM. The S1 heart sound is intensified due to the increased cardiac output .Emily’s heartbeat (




) normal affection sounds of a 16 year old female at rest, as listen with a stethoscope
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First heart sound: caused by atrioventricular valves –

Second heart sound caused by semilunar valves – Front of thorax, showing surface relations of bones lungs ( purple ), pleura ( blue ), and heart ( bolshevik outline ). The locations of best auscultation for each heart valve are labeled with “ M ”, “ T ”, “ A ”, and “ P ” .First center sound : caused by atrioventricular valves – Mitral ( M ) and Tricuspid ( T ) .Second heart sound caused by crescent valves – Aortic ( A ) and Pulmonary/Pulmonic ( P ). Heart sounds are the noises generated by the beat kernel and the result flow of blood through it. specifically, the sounds reflect the turbulence created when the heart valves tear exclude. In cardiac auscultation, an examiner may use a stethoscope to listen for these singular and discrete sounds that provide significant auditory data regarding the condition of the kernel. In goodly adults, there are two normal heart sounds, often described as a lub and a dub that occur in sequence with each pulse. These are the first heart sound ( S1 ) and second heart sound ( S2 ), produced by the close up of the atrioventricular valves and crescent valves, respectively. In addition to these normal sounds, a assortment of early sounds may be present including heart murmur, adventitious sounds, and gallop cycle S3 and S4. Heart murmurs are generated by churning hang of lineage and a murmur vowel to be heard as disruptive flow must require pressure remainder of at least 30 millimeter of Hg between the chambers and the pressure prevailing chamber will outflow the blood to non-dominant chamber in diseased condition which leads to Left-to-right shunt or Right-to-left shunt based on the blackmail dominance. turbulence may occur inside or outside the heart ; if it occurs outside the center then the turbulence is called rumor or vascular murmur. Murmurs may be physiologic ( benign ) or diseased ( abnormal ). abnormal murmurs can be caused by stenosis restricting the opening of a heart valve, resulting in turbulence as blood flows through it. Abnormal murmur may besides occur with valvular insufficiency ( regurgitation ), which allows backflow of rake when the incapable valve closes with lone overtone effectiveness. different murmurs are audible in unlike parts of the cardiac hertz, depending on the induce of the mutter .

primary kernel sounds [edit ]

normal heart sounds are associated with kernel valves closing :

First heart sound [edit ]

The first heart sound, or S1, forms the “ lub ” of “ lub-dub ” and is composed of components M1 ( mitral valve settlement ) and T1 ( tricuspid valve closure ). normally M1 precedes T1 slenderly. It is caused by the closure of the atrioventricular valves, i.e. tricuspid and mitral ( premolar ), at the beginning of ventricular contraction, or systole. When the ventricles begin to contract, thus do the papillary muscles in each ventricle. The papillary muscles are attached to the cusp or leaflets of the tricuspid and mitral valves via chordae tendineae ( center strings ). When the papillary muscles sign, the chordae tendineae become strain and thereby prevent the backflow of blood into the lower coerce environment of the atrium. The chordae tendineae act a piece like the strings on a chute, and allow the leaflets of the valve to balloon up into the atrium slightly, but not then much as to evert the cusp edges and allow backflow of lineage. It is the blackmail created from ventricular contraction that closes the valve, not the papillary muscles themselves. The compression of the ventricle begins fair prior to AV valves close and prior to the opening of the crescent valves. The sudden strain of the chordae tendineae and the pinch of the ventricles against closed crescent valves, send lineage rushing back toward the atrium, and the parachute-like valves catch the race of lineage in their leaflets causing the valve to snap close. The S1 sound results from echo within the rake associated with the sudden forget of hang transposition by the valves. The check of T1 even more than normally causes the split S1 which is heard in a right bundle branch block. [ 1 ]

irregular kernel sound [edit ]

The second heart sound, or S2, forms the “ dub ” of “ lub-dub ” and is composed of components A2 ( aortal valve closure ) and P2 ( pneumonic valve closure ). normally A2 precedes P2 specially during inhalation where a disconnected of S2 can be heard. It is caused by the closure of the crescent valves ( the aortal valve and pneumonic valve ) at the end of ventricular systole and the begin of ventricular diastole. As the leave ventricle empties, its atmospheric pressure falls below the imperativeness in the aorta. aortal lineage flow quickly reverses back toward the left ventricle, catching the pocket-like cusp of the aortal valve, and is stopped by aortal valve blockage. similarly, as the blackmail in the justly ventricle falls below the pressure in the pneumonic artery, the pneumonic valve closes. The S2 voice results from repercussion within the blood associated with the sudden block of menstruation reversion. [ 1 ] divide of S2, besides known as physiologic split, normally occurs during inhalant because the decrease in intrathoracic imperativeness increases the time needed for pneumonic imperativeness to exceed that of the right ventricular pressure. A widely split S2 can be associated with respective unlike cardiovascular conditions, and the split is sometimes wide and variable whereas, sometimes wide and fixed. The wide and varying rent occurs in Right bundle branch stuff, pneumonic stenosis, pneumonic high blood pressure and ventricular septal defects. The wide and fasten rending of S2 occurs in atrial septal defect. pneumonic S2 ( P2 ) will be accentuated ( brassy P2 ) in pneumonic high blood pressure and pneumonic embolism. S2 becomes softer in aortal stenosis. [ 1 ]

excess center sounds [edit ]

The rare excess heart sounds shape gallop rhythm and are heard in both normal and abnormal situations. [ 1 ]

third heart sound [edit ]

The third affection good, or S3 is rarely heard, and is besides called a protodiastolic gallop, ventricular gallop, or colloquially the “ Kentucky “ gallop as an onomatopoeic citation to the rhythm and try of S1 followed by S2 and S3 together ( S1=Ken ; S2=tuck ; S3=y ). [ 2 ] “lub-dub-ta” or “slosh-ing-in” If new, indicates heart failure or volume overload. [ citation needed ] It occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth, some discipline athletes, and sometimes in pregnancy but if it re-emerges late in biography it may signal cardiac problems, such as a fail bequeath ventricle as in elaborate congestive center failure ( CHF ). S3 is thought to be caused by the oscillation of lineage back and forth between the walls of the ventricles initiated by blood rushing in from the atrium. The reason the one-third center sound does not occur until the middle third gear of diastole is credibly that during the early part of diastole, the ventricles are not filled sufficiently to create adequate tension for echo. [ 1 ] It may besides be a resultant role of tense of the chordae tendineae during rapid occupy and expansion of the ventricle. In other words, an S3 center good indicates increase volume of blood within the ventricle. An S3 heart healthy is best listen with the bell-side of the stethoscope ( used for lower frequency sounds ). A left-sided S3 is best hear in the leave lateral decubitus stead and at the vertex of the kernel, which is normally located in the fifth left intercostal distance at the midclavicular note. A right-sided S3 is best learn at the lower left sternal border. The means to distinguish between forget and right-sided S3 is to observe whether it increases in intensity with inhalation or halitus. A right-sided S3 will increase on inhalant, while a left-sided S3 will increase on exhalation. [ 1 ] S3 can be a convention determination in unseasoned patients but is generally pathologic over the old age of 40. The most common cause of diseased S3 is congestive heart failure. [ 1 ]

Fourth center sound [edit ]

The fourth affection legal, or S4 when audible in an adult is called a presystolic gallop or atrial gallop. This gallop is produced by the sound of rake being forced into a stiffly or hypertrophic ventricle. [ 1 ] “ta-lub-dub” or “a-stiff-wall” It is a polarity of a pathological state, normally a failing or hypertrophic left field ventricle, as in systemic high blood pressure, dangerous valvular aortal stenosis, and hypertrophic cardiomyopathy. The audio occurs just after atrial contraction at the end of diastole and immediately before S1, producing a rhythm sometimes referred to as the “ Tennessee “ gallop where S4 represents the “ Ten- ” syllable. [ 2 ] It is estimable heard at the cardiac apex with the affected role in the left lateral pass decubitus situation and holding his breath. The unite presence of S3 and S4 is a quadruple gallop, besides known as the “ Hello-Goodbye ” gallop. At rapid heart rates, S3 and S4 may merge to produce a summation gallop, sometimes referred to as S7. [ 1 ] atrial contraction must be confront for production of an S4. It is absent in atrial fibrillation and in other rhythm in which atrial contraction does not precede ventricular contraction. [ 1 ]

Murmurs [edit ]

Phonocardiogram from normal and abnormal heart sounds.

Heart murmur (




) ventricular septal defect murmur vowel in 14 class erstwhile Rachel Morrison ‘s kernel, heard from the mitral valve area .
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Mitral valve prolapse murmur (




) Heart sounds of a 16-year-old girlfriend diagnosed with mitral valve prolapse and mitral vomit. Auscultating her heart, a systolic murmur and snap are heard. Recorded with the stethoscope over the mitral valve .
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Heart murmurs are produced as a result of disruptive flow of rake strong adequate to produce audible noise. They are normally heard as a whoosh voice. The term murmur lone refers to a strait believed to originate within blood stream through or near the heart ; rapid rake speed is necessary to produce a murmur vowel. Most heart problems do not produce any mutter and most valve problems besides do not produce an audible mutter. [ 3 ] Murmurs can be heard in many situations in adults without major congenital heart abnormalities : [ 3 ]

  • Regurgitation through the mitral valve is by far the most commonly heard murmur, producing a pansystolic/holosystolic murmur which is sometimes fairly loud to a practiced ear, even though the volume of regurgitant blood flow may be quite small. Yet, though obvious using echocardiography visualization, probably about 20% of cases of mitral regurgitation do not produce an audible murmur.[3]
  • Stenosis of the aortic valve is typically the next most common heart murmur, a systolic ejection murmur. This is more common in older adults or in those individuals having a two-leaflet, not a three-leaflet, aortic valve.[ quotation needed]
  • Regurgitation through the aortic valve, if marked, is sometimes audible to a practiced ear with high quality, especially electronically amplified, stethoscope. Generally, this is a very rarely heard murmur, even though aortic valve regurgitation is not so rare. Aortic regurgitation, though obvious using echocardiography visualization, usually does not produce an audible murmur.[ citation needed]
  • Stenosis of the mitral valve, if severe, also rarely produces an audible, low frequency soft rumbling murmur, best recognized by a practiced ear using high quality, especially electronically amplified, stethoscope.
  • Other audible murmurs are associated with abnormal openings between the left ventricle and right heart or from the aortic or pulmonary arteries back into a lower pressure heart chamber.

Gradations of Murmurs

(Defined based on use of an acoustic, not a high-fidelity amplified electronic stethoscope)


Grade 1

Very faint, heard only after listener has “tuned in”; may not be heard in all positions. Only heard if the patient “bears down” or performs the Valsalva maneuver.

Grade 2

Quiet, but heard immediately after placing the stethoscope on the chest.

Grade 3

Moderately loud.

Grade 4

Loud, with palpable thrill (a tremor or vibration felt on palpation)[4]

Grade 5

Very loud, with thrill. May be heard when stethoscope is partly off the chest.

Grade 6

Very loud, with thrill. May be heard with stethoscope entirely off the chest.

Though several unlike cardiac conditions can cause kernel murmurs, the murmurs can change markedly with the austereness of the cardiac disease. An astute doctor can sometimes diagnose cardiac conditions with some accuracy based largely on the grumble, associate forcible interrogation, and know with the proportional frequency of different heart conditions. however, with the advent of better quality and wider handiness of echocardiography and other techniques, heart condition can be recognized and quantified much more accurately than once possible with only a stethoscope, examination, and know. Another advantage to the manipulation of the echocardiogram is that the devices can be handheld. [ 5 ]

Effects of breathing [edit ]

Heartbeat while holding breath (




) Heart sounds of a 16-year-old girlfriend with mitral regurgitation holding her breath .
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inhalation decreases intrathoracic coerce which allows more venous blood to return to the right heart ( pulling rake into the right slope of the heart via a vacuum-like consequence ). therefore, right-sided center murmurs by and large increase in volume with inhalation. The decreased ( more veto ) intrathoracic pressure has an reverse effect on the leftover side of the heart, making it harder for the rake to exit into circulation. consequently, left-sided murmurs generally decrease in intensity during inhalation. Increasing venous rake return to the justly side of the affection by raising a patient ‘s legs to a 45-degree while lying supine produces like impression which occurs during inhalant. inhalation can besides produce a non-pathological rent S2 which will be heard upon auscultation. [ citation needed ] With exhalation, the diametric haemodynamic changes occur : left-sided murmurs by and large increase in volume with halitus. [ citation needed ]

Interventions that change murmurs [edit ]

There are a number of interventions that can be performed that interpolate the intensity and characteristics of abnormal heart sounds. These interventions can differentiate the different heart sounds to more effectively obtain a diagnosis of the cardiac anomaly that causes the affection strait. [ citation needed ]

other abnormal sounds [edit ]

Clicks – Heart clicks are light, high-pitched sounds that can be appreciated with modern non-invasive visualize techniques. [ citation needed ] Rubs – The pericardial friction rub can be heard in pericarditis, an ignition of the pericardium, the sac surrounding the heart. This is a feature scratch, creaking, high sound emanating from the rubbing of both layers of ablaze pericardium. It is the loudest in systole, but can often be heard at the beginning and at the end of diastole. It is very pendent on body put and breathe, and changes from hour to hour. [ citation needed ]

Surface human body [edit ]

The aortal area, pneumonic area, tricuspid sphere and mitral area are areas on the surface of the chest where the heart is auscultated. [ 6 ] Heart sounds result from repercussion within the lineage associated with the sudden engine block of menstruate transposition by the valves close. Because of this, auscultation to determine function of a valve is normally not performed at the side of the valve, but at the placement to where the sound waves reflect. [ citation needed ]

Recording heart sounds [edit ]

Using electronic stethoscopes, it is possible to record heart sounds via send output to an external recording device, such as a laptop or MP3 recorder. The same connection can be used to listen to the previously recorded auscultation through the stethoscope headphones, allowing for a more detail study of murmurs and other kernel sounds, for general inquiry ampere well as evaluation of a particular patient ‘s condition. [ citation needed ]

See besides [edit ]

References [edit ]

source : https://nutritionline.net
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