Abnormal Heart Sound Daryl P Lofaso MEd RRT Heart Sound Locations Heart Sounds S 1 lub occurs at the beginning of systole mitral and tricuspid close S 2 dub ID: 1037106
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1. CSI 201 - Skills Lab 3Abnormal Heart SoundDaryl P. Lofaso, M.Ed, RRT
2. Heart Sound Locations
3. Heart SoundsS1: “lub” occurs at the beginning of systole (mitral and tricuspid close)S2: “dub” marks the start of diastole, (aortic and pulmonic close)S3: early signs of CHF (ventricular gallop) S4: pulmonic stenosis, aortic stenosis, hypertension, MI & cardiomyopathy (atrial gallop)
4. Cardiac MurmursThree Main FactorsHigh flow rate through normal or abnormal orificesForward flow through a constricted or irregular orifice or into a dilated vessel or chamberBackward or regurgitant flow through an incompetent valve, septal defect, or patent ductus arteriosus.
5. Timing of Heart SoundsSystolic: Between S1 and S2Diastolic: Between S2 and S1 Holosystolic: continuous throughout systole
6. Loudness Scale: 1-6Grade 1: Very faintGrade 5: Loud with palpable precardical thrillGrade 6: Audible even when the stethoscope is lifted off chest
7. Heart Sounds: PitchLow-velocity – low pitched rumbling (mitral stenosis)Large diastolic pressure gradient – high pitched murmur (aortic regurgitation)
8. Systolic MurmursSystolic murmurs can be divided intoMid-systolicHolo-systolic (pan-systolic)
9. Systolic MurmurMid-Systolic MurmursAortic Stenosis Radiates to carotid arteries; harsh or barkingPulmonic StenosisNote: blood flow in a normal direction across a valve that is narrowed or calcified.Hypertrophic cardiomyopathyFlow murmurNote: valve is normal but the flow is increased and this causes turbulence.
10. Systolic MurmurHolo-systolic murmursMitral regurgitationMedium-pitched blowingTricuspid regurgitationVentricular septal defect (VSD)Note: blood flowing the wrong way when the ventricle contracts
11. Diastolic MurmursDiastolic murmurs can be divided intoEarly diastolic murmursDiastolic rumbles
12. Diastolic murmurEarly Diastolic MurmursEarly Diastolic Murmurs (decrescendo) Aortic Insufficiency (Regurgitation)Blowing early diastolicPulmonic InsufficiencyAccentuated P2Note: blood flowing the wrong way (backwards) during diastole
13. Diastolic MurmursDiastolic RumblesDiastolic Rumbles (low-pitched rumble)Mitral stenosisOpening snap with mid-diastolic rumbleTricuspid stenosis Mid-diastolic rumble, louder with inspiration & decrease with exhalationNote: blood flow is normal, but across a narrowed valve opening