• Physiology – Heart sounds

    by  • 11/10/2013 • Cardiology

    1. S1 = closure of AV valves
    2. S2 = closure of aortic/pulmonary valves (A2 / P2)
    3. Pathological murmurs = valve stenosis / regurg
    4. Non-pathological = Still’s murmur = turbulence of flow in context of normal vales. A benign paediatric murmur. Position – dependant, soft (3/6), only in systole or pan (not isolated in diastole = pathological!)
    5. S3 = ‘ventricular gallop rhythm’ = lower pitch than S1/2, follows S2, in young healthy or pregnant, or path in CHF. S3 indicates increased blood volume within ventricles – if right sided – louder on inspiration, if L sided – louder on expiration.
    6. S4 = ‘atrial gallop rhythm’ = blood banging with force into stiff hypertrophic ventricles (=LVH/R-CMP). Occurs just before S1.
    7. S3+S4 = ‘quadruple rhythm’
    8. S7 = if S3 and S4 are present and heart rate is rapid = ‘summation gallop’.
    9. Right side of heart never produces audible murmurs = pressure too low.
    10.  ‘Clicks’ = in calcified stenotic valves
    11.  ‘Rubs’ = in pericarditis (eased by sitting up, worsened by laying flat). 
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