Transcript Venous Pressure AND Heart Sound

Heart sound
Area Of Auscultation
Area Of Auscultation
 Pulmonary
border
 Aortic
border
 Mitral
valve second intercostal space, left upper sternal
valve second intercostal space ,right upper sternal
valve fifth intercostal space , left midclavicular line
 Tricuspid
border
valve fourth intercostal space, lower left sternal
What we hear ?

We have all heard the heart make the
usual sounds.
LUB----------DUB

Lub is the first sound or S1

Dub is the second heart sound or S2
NormalNormal
heart souands
First heart sound S1
The “lub” in the lub – dub.
 This sound is primarily because of the closing
of the bicuspid and tricuspid valves.
 Anatomically they are located between the
atria and the ventricles
 They close because the ventricles contract
 The Pulmonic and Aortic valves are opening
and blood is being forced into the arteries
 Its maximum intensity is at the apex
S1 abnormalities

Loud S1
Mitral stenosis
Tachycardia
/hyperkinetic status

Soft S1
Mitral regurgitation
Heart failure
 Obesity
 Shock
 Pericardial effusion
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 as the
pressure from the arteries is greater then
the pressure in the ventricles.
 This
is the end of systole
S2 components:
Has two components A2 and P2
 Inspiration decreases intrathoracic pressure,
increases RV filling
 RV is relatively weak, and an increase in filling results
in slower emptying



Inspiration delays P2, causing audible splitting of S2
P2 localized to pulmonary area while A2 audible all over the
pericardium with max. intensity at aortic area
S2
S2 abnormalities

Loud P2
Pulmonary hypertension

Soft P2
Pulmonary stenosis


Loud A2
Systemic hypertension
Soft A2
Aortic stenosis
Aortic regurgitation
Split abnormalities
Wide splitting
Delay pulmonic closure:
RBBB
Pulmonary hypertension
Pulmonic stenosis
Early aortic closure:
MR

Fixed splitting
Atrial septal defect

Reversed splitting
Lf bundle branch block
Sever aortic stenosis

S2
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
Third heart sound S3
Is a low pitched early diastolic sound best heard with
the bell at the apex.
 also called ventricular gallop
 Occure with rapid ventricular filling after the AV
valves open.
 It is best heard with the bell-side of the stethoscope
at the apex of the heart
 Causes
 Normally in Children and during pregnancy
 Pathological
LVF
MR

Fourth heart sound S4
Low pitched sound occurs at late diastole
due to atrial contraction if ventricles are non
complaint. Just before S1
 Called a presystolic gallop or atrial gallop
 It is always pathological
 Causes:
Hypertension
Cardiomuopathy
AS

Murmurs
These are abnormal sound and are longer
duration s compared to heart sound
produced due to the turbulence of blood
flow through valves
 Three Types:
Systolic murmurs
Diastolic murmurs
Continuous machinary murmur

Ejection systolic murmur
Pansystolic systolic murmur
Mid-Diastolic murmur
Early diastolic murmur
Continuous machinary murmur