For class I made this

1. KazanState
Medical
UniversityPhysiology Project
Heart Sounds

2. Heart Sounds

3. Heart s ounds :• The mechanical activities of the heart during
each cardiac cycle, cause the production of
some sounds, which are called heart sounds.
Fact ors involved in t he
product ion of heart sounds
are:
• The movement of blood through chambers of
the heart.
• The movement of cardiac muscle.

4. Cardiac Cycle

6. Systolic vs.
Diastolic
systole
S1 S2
diastole

7. Gallops
systole
S1 S2
S4 S3
diastole

8. Fi rs t heart s ound (S1):
• It is produced during isometric
contraction and earlier part of
ejection period.
• It resembles spoken word ‘LUBB’.
Characteristics:
• It is long, soft, low pitched sound.
• Duration of this sound is 0.10 –
0.17 sec
Causes:
• It mainly occurs due to sudden
closure of atrioventricular valves.
FirstheartsoundandECG:
• It coincides with peak of ‘R’ wave
of ECG

9. Abnormal S1
• Loud Fi rs t Heart Sound
– Hyperdynamic (fever, exercise)
– Mitral stenosis
– short AV intervals like Wolff-Parkinson-
White syndrome
• Sof t Fi rs t Sound
– Low cardiac output (rest, heart failure)
– Tachycardia
– Severe mitral reflux (caused by destruction of
valve)
– long PR interval
• Vari abl e I nt ens i t y of
Fi rs t Sound
– Atrial fibrillation
– Complete heart block

10. Second heart
s ound(S2):• It pro duces during the o nset o f diasto le.
• It resembles the spo ken wo rd ‘ DUBB’
Characteristics:
• It is sho rt, sharp and high pitched so und.
• Duratio n o f this so und is 0.1 0 – 0.1 4 seco nds.
Causes:
• It mainly pro duces during sudden clo sure o f the
semilunar valves.
SecondheartsoundandECG:
• It co incides with the ‘ T’ wave o f ECG.

11. AbnormalS2
• LoudSecondHeartSound(aortic)
– Systemic hypertensio n
– Dilated ao rtic ro o t
• SoftSecondHeartSound(aortic)
– Calcified ao rtic steno sis
• LoudSecondHeartSound
(pulmonary)
– Pulmo nary hypertensio n

12. Third heart sound(S3):• It isproduced during rapid filling period of thecardiac cycle.
• Heard in early diastole
• Lub-dub-by cadencesimilar to "Kentucky“ SLOSH’-ing-in
• May benormal physiological finding in patientslessthan age30.
Characteristics:
• It isshort and low pitched sound.
• Duration of thissound is0.07 – 0.10 seconds.
Causes:
• It isproduced dueto thevibrationswhich set up in ventricular wall, dueto rushing of blood in to
ventriclesduring rapid filling phase.
ThirdheartsoundandECG:
• It appearsbetween ‘T’ and ‘P’ wavesof ECG.
congestive heart failure, which is the
most common cause of a S3.
S3 is low frequency and thus
best heard with the bell of the
stethoscope at the apex while
the patient is in the left lateral
decubitus position. .

13. Fourt h heart
s ound(S4):• It is produced during atrial systole
and considered as physiologic heart
sound.
Characteristics:
• It isshort and low pitched sound.
• Duration of the sound is 0.02 –
0.04 seconds.
Causes:
• It occurs due to vibrations which
set up in atrial musculature during
atrial systole.
FourthheartsoundandECG:
• It coincides with interval between

14. Tri pl e heart
s ound:• In some conditions like myocardial
infarction and severe hypertension,
theintensity of third and fourth heart
sounds increases and they could be
heard as a single sound along with
the first and second heart sound.
Thisisknown astripleheart sound.
Importance of the heart
sounds:
• Heart sound generally alters during
cardiac diseases involving thevalves
of the heart. That’s why heart

15. Gal l op Sounds
Gallops & Other Sounds
Sound Answer
Normal
Split S1
Split S2
S3
S4
Summation Gallop

16. The
St et hos cope• The Bell
– used to hear low-pitched sounds
– used for mid-diastolic murmur of mitral
stenosisor S3 in heart failure
• The Diaphragm
– filtersout low-pitched sounds
– highlightshigh-pitched sounds
– used for analyzing thesecond heart sound,
ejection and midsystolic clicksand for the
soft but high-pitched early diastolic
murmur of aortic regurgitation

17. Pos i t i oni n
g• Patientscan beexamined whilelying
supine, in theleft lateral decubitus
position, sitting, and leaning forward.

18. Li s t eni ng
Pos t s

19. Met hods t o s t udy heart
s ounds :• Therearethreemethods tostudyheartsounds:
1. By using stethoscope
2. By using microphone
3. By using phonocardiogram
Stethoscope:
• The chest piece of the stethoscope is placed over 4
areas of the chest, which are called auscultatory
areas. Theauscultatory areasareasfollow:
1. Mitralareaorbicuspidarea:
• Situated in the left V intercostal space about 3
inches from midline. This is the area of apex beat.
Mitral valvesound best heart near thisregion.
2. Tricuspidarea:
• Present over xiphoid process . Tricuspid valve
sound best heart near thisregion.
3. Pulmonaryarea:
• Present over the left II intercostal space close to the
sternum. Semilunar valve sound best heart near this
region.
4. Aortic area:
• Situated over right II intercostal space near to the
sternum. Semilunar valve sounds are best heard
near thisregion.
 First heart sound is best heard in mitral and
tricuspid area where second heart sound is best

20. Referances
ht t p:/ / dept s.washingt on.edu/ physdx/ heart / t ech.ht ml
ht t p:/ / www.med.ucla.edu/ wilkes/ Syst olic.ht m
ht t p:/ / www.medst udent s.com.br/ cardio/ hear t sounds/ heart sou.ht m
ht t p:/ / www.uni-duesseldorf .de/ WWW/ MedFak/ Herz-Kreislauf -Physiologi
ht t ps:/ / en.wikipedia.org/ wiki/ Phonocardiogram
ht t p:/ / m4.wyanokecdn.com/ da17293e98727bf a9ead2837
402211d6.j pg
ht t p:/ / www.healio.com/ pediat rics/ j ournals/ pedann/ 1997-
2-26-2/ %7B4ef b230a-be51-4933-9732-
ab24a5950958%7D/ what -makes-a-heart -murmur-
innocent
ht t p:/ / radiologykey.com/ phonocardiography/ # 8760709

21. Thank you Very
much