Study of Heart Sounds in Man PDF

JCADELUNA,DMD, MSHSE STUDY OF HEART SOUNDS IN MAN HEART SOUNDS JCADELUNA,DMD, MSHSE ▪ Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it ▪ In cardiac auscultation, an examiner may use a stethoscope to listen for...

JCADELUNA,DMD, MSHSE STUDY OF HEART SOUNDS IN MAN HEART SOUNDS JCADELUNA,DMD, MSHSE ▪ Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it ▪ In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart to a trained observer. JCADELUNA,DMD, MSHSE ▪ In healthy adults, there are two normal heart sounds JCADELUNA,DMD, MSHSE often described as a lub and a dub (or dup), that occur in sequence with each heartbeat. ▪ Normal heart sounds are associated with heart valves closing, causing changes in blood flow. ▪ first heart sound (S1) - It is caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves, i.e. tricuspid and mitral ▪ second heart sound (S2) - It is caused by the sudden block of reversing blood flow due to closure of the semilunar valves (the aortic valve and pulmonary valve) JCADELUNA,DMD, MSHSE  JCADELUNA,DMD, MSHSE four classical auscultation areas: apex, lower left, upper left and right sternal edges. Known as the: ▪mitral/apex area, (5th intercostal space, mid clavicular line) ▪tricuspid area, (around the 3rd, 4th and 5th left ICSs, at the left sternal edge, LSE) ▪pulmonary area (2nd left ICS lateral to sternum, LSE) and ▪aortic area (2nd right ICS lateral to sternum). JCADELUNA,DMD, MSHSE JCADELUNA,DMD, MSHSE JCADELUNA,DMD, MSHSE  JCADELUNA,DMD, MSHSE Abnormal Heart Sounds ▪ S3: The S3 sound is heard immediately following S2, and is normal in children and adolescents, but usually disappears after age 30. When heard in adults, an S3 is called a “gallop” and indicates left ventricular failure. ▪ S4: The S4 sound is heard immediately before the S1, and may be present in infants and children. The S4 is produced with decreased compliance of the ventricle and may indicate myocardial infarction or shock.  JCADELUNA,DMD, MSHSE Heart murmurs ▪Heart murmurs are produced as a result of turbulent flow of blood. ▪ They are usually heard as a whooshing sound. ▪ The term murmur only refers to a sound believed to originate within blood flow through or near the heart; ▪ rapid blood velocity is necessary to produce a murmur.  JCADELUNA,DMD, MSHSE ▪incompetent valve - swishing sound just AFTER the normal "lub" or "dub"; valve does not completely close, some regurgitation of blood ▪Stenotic valve - high pitched swishing sound when blood should be flowing through valve; narrowing of outlet in the open state Gradations (Defined based on use of an acoustic, not a high- of JCADELUNA,DMD, MSHSE fidelity amplified electronic stethoscope) Murmurs Grade Description Very faint, heard only after listener has "tuned in"; may Grade 1 not be heard in all positions. Only heard if the patient "bears down" or performs the Valsalva maneuver. Quiet, but heard immediately after placing the Grade 2 stethoscope on the chest. Grade 3 Moderately loud. Loud, with palpable thrill (i.e., a tremor or vibration felt Grade 4 on palpation) Very loud, with thrill. May be heard when stethoscope Grade 5 is partly off the chest. Very loud, with thrill. May be heard with stethoscope Grade 6 entirely off the chest. JCADELUNA,DMD, MSHSE JCADELUNA,DMD, MSHSE