Heart Sounds

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Pages Below:

Aortic Regurgitation
Aortic Stenosis
Innocent Murmurs
Mitral Regurgitation
Mitral Stenosis
Mitral valve prolapse
Mixed Aortic Valve Disease
Mixed Mitral Valve Disease
Prosthetic Heart Valves

First Heart Sound

• closure of mitral and tricuspid valves

Second Heart Sound

• closure of aortic and pulmonary valves
• may be split in children and young adults during inspiration
  • widened by decreased right ventricular contraction
    • right bundle branch block
    • pulmonary valve stenosis
• abnormally split if in expiration
  • delayed by left ventricular contraction
    • left bundle branch block
    • Hypertrophic Obstructive Cardiomyopathy
• fixed splitting
  • atrial septal defect

Third Heart Sound

• low pitched thud in diastole - end of ventricular filling
• physiological
  • young, fit with increased output
  • e.g. athletes, fever, pregnancy
• pathological (gallop rhythm)
  • dilated cardiomyopathy
  • acute Myocardial Infarction
  • acute massive Pulmonary Embolism

Fourth Heart Sound

• atrial contraction
• left atrial hypertrophy
  • Hypertension
  • Hypertrophic Obstructive Cardiomyopathy
  • NOT Mitral Stenosis

Ejection click

• shortly after first heart sound
• opening of deformed aortic / pulmonary valve
• or dilated pulmonary artery / ascending aorta

Opening Snap

• diastolic sound in Mitral Stenosis 
• best heard to left of sternum

Mid-systolic click

• associated with Mitral valve prolapse

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