Transcript Venous Pressure AND Heart Sound

Heart sound
What we hear ?
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We have all heard the heart make the usual
sounds.
LUB----------DUB
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Lub is the first sound or S1
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Dub is the second heart sound or S2
First heart sound S1
The “lub” in the lub – dub.
 This sound is primarily because of the closing
of the mitral and tricuspid valves.
 Anatomically they are located between the
atria and the ventricles
 They close because the ventricles contract
S1
Louder than usual - Mitral Stenosis
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Diminished Mitral or Aortic Regurg.
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Second heart sound S2
S2 is the “dub” in the lub- dub
 The sounds are because of the closing of the
Pulmonic and Aortic valves.
 This is the end of systole
S2
Wide split sounds or fixed 
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Atrial Septal Defect
RBBB
Pulmonic Stenosis
Systole
The time between the S1 and S2 sounds is:
Lub------------Dub
The ventricles contracting
Blood flowing from the heart to the lungs and
body
Blood flowing across the Pulmonic and Aortic
valves
Diastole
The time between S2 and S1 is :
Dub----------Lub
The blood is flowing from the atria to the
ventricles.
The blood flowing across the bicuspid and
tricuspid valves.
The atrial contraction also occurs now
Area Of Auscultation
Area Of Auscultation
Pulmonary valve second intercostal space, left upper
sternal border
Aortic valve second intercostal space ,right upper
sternal border
Mitral valve fifth intercostal space , left midclavicular
line
Tricuspid valve fourth intercostal space, lower left
sternal border
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S3 Third heart sound
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also called a protodiastolic gallop, ventricular
gallop
caused by Rapid ventricular filling.
It occurs at the beginning of diastole after S2.
The third heart sound is benign in youth, some
trained athletes, and sometimes in pregnancy
The commonest causes are left ventricular failure and
mitral regurgitation
It is best heard with the bell-side of the stethoscope
at the apex of the heart .
S4 fourth heart sound
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called a presystolic gallop or atrial gallop.
This gallop is produced by the sound of blood being
forced into a stiff/hypertrophic ventricle.
It is a sign of a pathologic state, (left ventriclular
hypertrophy, hypertension, aortic stenosis)
It is best heard with the bell-side of the stethoscope
at the apex of the heart .
LUB-- DUB-------------LUB—DUB
S1
S2
S3
S4 S1
S2
Here is where you expect to hear the various
sounds
Added sound
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Clicks
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Rubs
Heart murmurs
Heart murmurs are generated by turbulent flow of blood, which
may occur inside or outside the heart.
Murmurs may be physiological (benign) or pathological
(abnormal).
Abnormal murmurs can be caused by stenosis restricting the
opening of a heart valve, resulting in turbulence as blood flows
through it.
Abnormal murmurs may also occur with valvular insufficiency
(or regurgitation), which allows backflow of blood when the
incompetent valve closes with only partial effectiveness.
Different murmurs are audible in different parts of the cardiac
cycle, depending on the cause of the murmur
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Heart murmurs are most frequently organized by
diastolic and systolic heart murmurs timing, into
.heart murmurs
cannot be directly continuous murmurs ,However
placed into either category
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Thank you