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Normal and abnormal Heart sounds (Murmurs).pptx
The document discusses normal and abnormal heart sounds, highlighting the physiological mechanisms behind these sounds, such as valve closures during heart cycles. It covers specific conditions affecting heart sounds, like murmurs caused by turbulence in blood flow and their classification based on location, timing, quality, and intensity. Additionally, it details common murmurs, their characteristics, and significance in diagnosing cardiovascular issues.
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Normal and abnormal Heart sounds (Murmurs).pptx
- 1. Normal and abnormal Heart sounds(Murmurs) By Dr. Irtaza Rehman (Author of The Extraordinary Life)
- 3. Learning Objectives • Tolearn about the Normal heart sounds • To learn about the Abnormal heart sounds
- 4. Normal Heart sounds •Produced by the closure of Atrio-ventricular valves (Mitral and tricuspid) and Semilunar valves (aortic & pulmonary)
- 5. Normal Heart sounds Sitesfor Auscultation
- 7. Normal Heart sounds SystoleSystole Systole Diastole Diastole
- 9. • S2: A2(Aortic valve closure) • Loud A2: Systemic Hypertension (High B.P will create louder noise) • Low A2: Systemic Hypotension, Aortic regurgitation (destruction of valve tissue and impairment of the valve closure mechanism) Normal Heart sounds
- 10. • S2: P2(Pulmonary valve closure) • Loud P2: Pulmonary hypertension, ASD (Blood shunting from left to right atrium right ventricle Pulmonary artery Loud P2) • Low/soft P2: Pulmonary stenosis Normal Heart sounds
- 11. • S1 splitting •Normally T1 (Tricuspid closure) comes later than M1 due to slightly earlier closure of Mitral valve. • But this splitting is very narrow, almost negligible. May not be present at all. • So normally there is no splitting in S1. Normal Heart sounds
- 12. • S1 splitting •Delayed T1: RBBB (due to slower conduction on right heart, Tricuspid valve will close with further delay than Mitral valve) Normal Heart sounds
- 13. • S1 splitting •Reverse splitting: LBBB, Severe MS (as mitral valve will close with a delay after Pulmonary valve in both condition). M1T1 pattern will be reversed. • T1 M1 Normal Heart sounds
- 14. • S2 splitting •S2 is normally split because the aortic valve (A2) closes before the pulmonary valve (P2) • Split is more prominent in inspiration. Normal Heart sounds
- 15. • S2 splitting •Wide splitting: splitting gets wide and wider in inspiration. In RBBB, Pulmonary stenosis ( late movt of P.v) • Fixed splitting: Equal delay in both Ins & Exp. In ASD (Blood shunting from left to right atrium right ventricle Pulmonary artery Late closure of P.v) • Paradoxical splitting: Aortic valve moves slower. Aortic stenosis, LBBB) Normal Heart sounds
- 16. Third heart sound •In early diastole • Normally present in Kids, Young adults, athletes, pregnancy • In older (congestive heart failure) Due to rapid ventricular filling during diastole Ventricular gallop
- 17. How to differentiate bwS3 and S2 Splitting? S3 S2 split ◦ Low pitch High pitch ◦ Heard by the Bell Heard by diaphragm ◦ At the Apex At the base Aortic area (5th ICS MCC)
- 18. Fourth heart sound •In late diastole • Always pathological • Heard at the Apex • Low pitch • HOCM, Hypertension, Acute MI When atria contracts in non compliant/stiff ventricles Atrial gallop
- 19. Murmurs • Murmurs areextra or unusual sounds made by blood circulating through the heart's chambers or valves, or through blood vessels near the heart.
- 20. • Murmurs areproduced due to any sort of turbulence in normal blood flow across heart. • Causes of turbulence: i. Increase velocity of blood ii. Decrease diameter (ASD, VSD) Decreased diameter will inc. the velocity. iii. Incompetent valves ( Valvular heart diseases) iv. Decrease viscosity of blood (Anemia) v. Increase contractile strength of heart: Leads to hyperdynamic flow (Exercise, Fever, Sepsis, Pregnancy etc) Murmurs
- 21. Murmurs HOW MURMURS CANBE CLASSIFIED? Murmurs can be classified according to their: 1. Location 2. Timing 3. Quality 4. Radiation 5. Intensity Learn To Question Repeatedly & Intelligently
- 22. Location of murmurs •Aortic valve : Right 2nd ICS : A.S • Pulmonic Valve: Left 2nd ICS: P.S, P.R, ASD • Tricuspid valve: Left 5th ICS PSB: T.S, T.R, VSD • Mitral valve: Left 5th ICS MCL: M.R, M.S, MVP
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- 26. Quality of Murmur •A.R/MR Blowing/Musical • A.S/M.S Rumbling/Harsh • PDA Machine like
- 27. Radiation of Murmurs •While murmurs are usually most intense at one specific listening post, they often radiate to other listening posts or areas of the body. • Aortic stenosis To carotids • Aortic regurgitation To left sternal border • Mitral regurgitation To axilla
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- 29. Terminology • Regurgitation: Bloodflow through a structure normally closed during systole. • Stenosis: Blood flow through an abnormally narrowed structure/valve normally open in systole.
- 30. Important Common murmurs •Aortic stenosis: • Ejection systolic/Early systolic murmur • Crescendo-decrescendo • Diamond shaped • Harsh
- 31. • Aortic Regurgitation: •Early diastolic • Decrescendo • Blowing • Sharp S2 Important Common murmurs
- 32. • Mitral stenosis: •Mid diastolic • Opening snap (opening of the mitral valve) • Loud S1 • Rumbling Important Common murmurs
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- 34. • Mitral regurgitation: •Holosystolic/Pansystolic (Throughout systole) • Blowing • Radiated to axilla Important Common murmurs
- 36. Jazakumullahu Khair ♥ (MayALLAH swt reward you with goodness)