DIASTOLIC SOUNDS

Question 1

Very early diastolic sounds caused by abrupt deceleration during the opening of
stenotic mitral valve

Best heard medial to apex and along left sternal border

High pitched and can be distinguished from S2 by snapping quality (use diaphragm)

Becomes less audible with more calcification

Answer 1

Opening Snap (OS)

Question 2

Common in children and young adults up to 35-40 years old

Also, during the last trimester of pregnancy

Occurring early in diastole with rapid ventricle filling

Dull and low pitch (use bell lightly)

Best heard in left lateral decubitus position

Answer 2

S3 physiological

Question 3

Ventricular gallop (from cadence of 3 heart sounds which sound like “Kentucky”)

Heard in patients over 40

Arises from high left ventricular filling pressures and abrupt deceleration of inflow across mitral valve at the end of the
rapid filling phase of diastole

Caused by decreased myocardial contractility, heart failure, ventricular volume overload from aortic or mitral
regurgitation or left-to-right shunt

Answer 3

S3 pathological

Question 4

Atrial sound or atrial gallop

Occurs just before S1

Dull, low pitched and best heard at apex with bell

Occasionally normal in well trained athletes and older age groups

More commonly due to ventricular hypertrophy or fibrosis causing increased
stiffness and resistance (or reduced compliance) during ventricular filling following atrial contraction

Left-sided S4 due to hypertensive heart disease, aortic stenosis, or ischemic and hypertrophic cardiomyopathy
- Best heard at apex in left lateral decubitus position with a cadence like “Tennessee”)

Right-sided S4 (less common) is heard along lower left sternal border or below xiphoid

• Gets louder with inspiration
• Caused by pulmonary hypertension or pulmonic stenosis

S4 also associated with delayed conduction between atria and ventricles

• delay separates normally faint atrial sound from louder S1 and makes it audible
• S4 is never heard when there is no atrial contraction (atrial fibrillation)

Answer 4

S4

Question 5

Produces a quadruple rhythm of four heart sounds

At rapid heart rates these heart sounds fuse to form one extra loud heart sound known as a summation gallop

Answer 5

S3 and S4

Question 6

name this type of S4, affects which side of the heart?

due to hypertensive heart disease, aortic stenosis, or ischemic and hypertrophic cardiomyopathy

• Best heard at apex in left lateral decubitus position with a cadence like “Tennessee”)

Answer 6

Left-sided S4

Question 7

name this type of S4, affects which side of the heart?

(less common) is heard along lower left sternal border or below xiphoid

• Gets louder with inspiration
• Caused by pulmonary hypertension or pulmonic stenosis

Answer 7

Right-sided S4

Question 8

this heart sound is also associated with delayed conduction between atria and ventricles

• delay separates normally faint atrial sound from louder S1 and makes it audible
• S4 is never heard when there is no atrial contraction (atrial fibrillation)

Answer 8

S4