HEART
SOUNDS
Presented by
GROUP 2A & 3A
I. OBJECTIVE
To be able to distinguish the different heart sounds and to know the
factors responsible for their production.
II. PROCEDURE
1. Place the bell of the stethoscope lightly but firmly over the area
of the apex beat, normally located in the 5th ICS LMCL.
2. Then place the bell of the stethoscope on the 2nd ICS close to the
right and then to the left side, corresponding to the aortic and
pulmonary areas respectively.
3. Take note of the sound and listen carefully as to pitch, intensity
and duration.
CHEST SURFACE AREAS FOR AUSCULTATION
OF NORMAL HEART SOUNDS
1. Aortic Area – Upward along
the aorta
2. Pulmonic Area – Upward
along the pulmonary artery
3. Tricuspid Area – Over the
right ventricle
4. Mitral Area – Over the apex
of the left ventricle
III. RESULTS
PITCH INTENSITY DURATION
5th ICS LMCL High Loud Short
2nd ICS (Right) Low Softer Long
2nd ICS (Left) Low Soft Long
IV. REPORT AND CONCLUSION
A. Define the following:
1. Tachycardia – Fast heart beat
2. Bradycardia – Slow heart beat
B. What is heart murmur? Are all heart murmurs pathologic?
• Heart murmur is an abnormal sound, but not all heart
murmurs are pathologic since there is S1 and S2 heart sound
splitting.
• S1 splitting is delayed closure of AV valves.
ü 40-70% of population have normal S1 splitting.
IV. REPORT AND CONCLUSION
• Pathological S1 Splitting
o RBBB
o Hyperdynamic heart, tachycardia (fever)
o Mitral valve stenosis
• S2 splitting is the delayed closure of SL valves
o It is an expiratory splitting, where during exhalation, the
splitting is narrow and wider in inhalation.
• The aortic closes slightly ahead of the pulmonary valve, the
sound of aortic valve is louder than pulmonary valve.
IV. REPORT AND CONCLUSION
• Pathological S2 Splitting
o Loud aortic – systemic hypertension
o Soft aortic – calcified aortic stenosis
o Loud pulmonary – secondary hypertension
• Paradoxical Splitting – is when pulmonary closes first than aortic
valve, it is heard when there is hypertrophic cardiomyopathy.
o One heard sound when inspiring and splitting when expiring.
IV. REPORT AND CONCLUSION
C. What is the effect of an incompetent aortic valve on the
diastolic sound?
• Aortic regurgitation, when blood is jetting backward to the
ventricle which has low pressure during diastole. Murmur
results from turbulence of blood. The sound is “blowing”, high
pitched with swishing quality.
D. What is the effect narrowing of the mitral valve on the diastolic
sound?
• Mitral valve stenosis, difficulty of the blood to pass through
the stenosed or narrowed mitral valve from LA to LV.
IV. REPORT AND CONCLUSION
• The sound is usually weak and very low pitch.
• No sound is heard during the first third of diastole.
V. DISCUSSION
• The normal heart sound is usually heard as "lub, dub"
o "Lub" for the first heart sound or S1 that is caused by closure
of the AV valves.
o "Dub" sound is the second heart sound or S2 that is caused
by closure of the SL valves.
• There are also third heart sound (S3) and fourth heart sound (S4).
But only heard with the help of phonocardiogram and the bell of
the stethoscope that detects low frequency sound.
V. DISCUSSION
• S3 is heard in the beginning of the middle third of diastole,
usually refered to vantricular gallop. It is the oscillation of the
blood back and forth between the walls of the ventricles initiated
by inrushing of blood from the atria.
•
• S4 is heard during artial contraction, in rushing of blood into the
ventricles that generates vibration similar to S3.
V. DISCUSSION
• Normally the duration of each heart sound is slightly more that
0.10 second. With S1, 0.14 and S2, 0.11. S2 is faster since its
more tauter than S1, which vibrates for a shorter time than S1.
• S2 has higher frequency than S1 because of 2 reasons:
1. Tautness of the semilunar valves compared to less taut AV
valves.
2. Greater elastic coefficient of the taut arterial walls, provides
principal vibrating chambers for S2. Compared to less elastic
ventricular chambers in S1.
V. DISCUSSION
• The S1 is usually softer in the base and louder at the apex the S2
is the opposite, lounder on the base but softer on the apex.
• Based on the results, the heart beat is heard clearly on the apex
of the heart which is in the 5th intercostal spaces whereas in the
2nd intercostal the heart sound is usually softer than the apex.
