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## Assessment of Heart Sounds Auscultation of heart sounds can help diagnose different cardiac disorders. Areas to auscultate include the aortic area, pulmonary area, Erb's point, tricuspid area, and the apical area. The normal heart sounds represent closing of the valves. * The first heart sound...

## Assessment of Heart Sounds Auscultation of heart sounds can help diagnose different cardiac disorders. Areas to auscultate include the aortic area, pulmonary area, Erb's point, tricuspid area, and the apical area. The normal heart sounds represent closing of the valves. * The first heart sound (S1) "lub" is closure of the mitral and tricuspid valves (heard at apex/left ventricular area of the heart). * The second heart sound (S2) "dub" is closure of the aortic and pulmonic valves (heard at the base of the heart). There may be a slight splitting of the S2. The time between S1 and S2 is systole, and the time between S2 and the next S1 is diastole. Systole and diastole should be silent, although ventricular disease can cause gallops, snaps, or clicks, and stenosis of the valves or failure of the valves to close may cause murmurs. Pericarditis may cause a friction rub. ### Additional Heart Sounds * **Gallop rhythms:** * S3 occurs after S2 in children and young adults but may indicate heart failure or left ventricular failure in older adults (heard with the patient lying on their left side). * S4 occurs before S1 and occurs with ventricular hypertrophy, such as from coronary artery disease, hypertension, or aortic valve stenosis. * **Opening snap:** Unusual high-pitched sound occurring after S2 with stenosis of mitral valve from rheumatic heart disease. * **Ejection click:** Brief high-pitched sound occurring immediately after S1 with stenosis of the aortic valve. * **Friction rub:** Harsh, grating sound heard in systole and diastole with pericarditis. * **Murmur:** Sound caused by turbulent blood flow from stenotic or malfunctioning valves, congenital defects, or increased blood flow. Murmurs are characterized by location, timing in the cardiac cycle, intensity (rated from Grade I to Grade VI), pitch (low to high-pitched), quality (rumbling, whistling, blowing), and radiation (to the carotids, axilla, neck, shoulder, or back). ## Congestive Heart Failure ### Pathophysiology Congestive heart failure (Pathophysiology) is a symptom rather than a disease. It results from the inability of the heart to adequately pump the blood that is needed for the body. In children (primarily infants), CHF it most often occurs secondary to cardiac abnormalities with resultant increased blood volume and blood pressure: * **Right-sided failure** occurs if the right ventricle cannot effectively contract to pump blood into the pulmonary artery, causing pressure to build in the right atrium and the venous circulation. This venous hypertension can result in peripheral edema or ascites and hepatosplenomegaly. * **Left-sided failure** occurs if the left ventricle cannot effectively pump blood into the aorta and systemic circulation, increasing pressure in the left atrium and the pulmonary veins, with resultant pulmonary edema and increased pulmonary pressure. Children often have some combination of both right and left-sided failure, depending on their cardiac defect.