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Questions and Answers
What is the location where S1 is loudest?
What is the location where S1 is loudest?
- Second left intercostal space
- Right fourth intercostal space
- Left fourth intercostal space (correct)
- Second right intercostal space
What is the correct sequence of events during a cardiac cycle?
What is the correct sequence of events during a cardiac cycle?
- S2, ventricular contraction, S1, ventricular relaxation
- S1, ventricular relaxation, S2, ventricular contraction
- S1, ventricular contraction, S2, ventricular relaxation (correct)
- S1, ventricular relaxation, S2, ventricular contraction
Why is S1 not split?
Why is S1 not split?
- Because aortic and pulmonic valve closure occur during ventricular contraction
- Because mitral and tricuspid valve closure occur during ventricular relaxation
- Because aortic and pulmonic valve closure occur too close together
- Because mitral and tricuspid valve closure occur too close together (correct)
What is the normal physiologic phenomenon in younger patients?
What is the normal physiologic phenomenon in younger patients?
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What happens to pulmonic valve closure during inspiration?
What happens to pulmonic valve closure during inspiration?
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What is the location where extra heart sounds (S3 and S4) are typically heard?
What is the location where extra heart sounds (S3 and S4) are typically heard?
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Study Notes
Auscultation
- Auscultation is performed using the stethoscope diaphragm.
S1 - First Heart Sound
- S1 is the loudest over the left fourth intercostal space (mitral/tricuspid valve areas).
- S1 is produced when the mitral and tricuspid atrioventricular (A/V) valves close during ventricular contraction (systole).
S2 - Second Heart Sound
- S2 is heard along the second right and left intercostal spaces (aortic/pulmonic valve regions).
- S2 is produced when the pulmonic and aortic semilunar valves close during ventricular relaxation (diastole).
Identifying S1 and S2
- The time between S1 and S2 is shorter than the time between S2 and the next S1, helping to identify which sound is produced by mitral/tricuspid valve closure and which is produced by aortic/pulmonic valve closure.
Physiologic Splitting of S2
- A slight physiologic splitting of S2 is normal in younger patients.
- Split S2 has two parts: aortic (A2) and pulmonic (P2) valve closure.
- On inspiration, S2 splits into A2 and P2 due to delayed pulmonic valve closure.
- On expiration, S2 is a single sound.
S1 and S2 Patterns
- S1 doesn't split because mitral and tricuspid valve closure occur too closely together to be heard individually.
Extra Heart Sounds (S3 and S4)
- S3 and S4 produce a gallop rhythm.
- These sounds can be heard around the fourth intercostal space on the mid-clavicular line.
- They are considered normal up to ages 20-30.
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