Heart Sounds

1
Heart Sounds

• The second heart sound is the key to auscultation
  of the heart. Leatham A. 1964

2
Where do they come from?

• S1
• S2
• S3
• S4

• mitral tricuspid closure
• aortic pulmonary closure
• ventricular filling (relaxed)
• ventricular filling (active)

3
Heart sounds - timing
4
Where to listen?
5
Normal heart sounds
6
Differentiation S1 from S2

• Quality
• Cadence (diastole gt systole)
• S1 and pulse coincide

7
Loud first heart sounds

• atrial contraction is closer to systole
• abnormal valve texture

8
Split second sounds
Splitting of S2, like gold, is where you find it.
You may need to go prospecting
9
Second heart sound
persistent
fixed
reversed
normal
out
in
normal
RBBB
ASD
LBBB
10
S3
11
Value of S3 and gallops

• Prognostic importance of elevated jugular venous
  pressure and a third heart sound in patients with
  heart failure. Drazner et al NEJM 2001345(8)
  574-581.
• Third heart sound and elevated jugular venous
  pressure as markers of subsequent development of
  heart failure in patients with asymptomatic left
  ventricular dysfunction. Drazner et al AJM
  2003114(6)431-437.

12
SOLVD data
13
SOLVD data
14
S4
15
Summation Gallop
16
Practical points

• S3, S4, and summation gallops are
  indistinguishable if the heart rate is gt100bpm
  unless ...(?)
• Loud S1 think.
• Split S2 think
• S3 think
• S4 think

17
Dont ignore

• Gallop rhythms
• Loud heart sounds
• Split heart sounds