Heart Sounds

Question 1

What is the pathophysiology of S3?

Answer 1

Large amounts of blood hitting a compliant left ventricle

Question 2

Is S3 ever normal?

Answer 2

Yes, in children and young adults, pregnancy, and athletes

Question 3

What does an S3 sound indicate?

Answer 3

Occurs with fluid overload.

Indicates systolic heart failure, cardiomyopathy, severe mitral or tricuspid valve regurgitation

Question 4

When and where can S3 be heard? What does it sounds like?

Answer 4

Heard with the bell of the stethoscope at the apex of the heart

Occurs early in diastole after S2

Sounds like ‘sloshing in’

Question 5

What is the other name for S3?

Answer 5

Ventricular gallop

Question 6

What is the pathophysiology of S4?

Answer 6

S4 is caused by the atria contracting forcing blood into a non-compliant ventricle

Question 7

Is S4 ever a normal finding? What does it indicate?

Answer 7

S4 is always an abnormal finding

It is associated with fluid overload

It indicates diastolic heart failure, aortic stenosis, cardiomyopathy and myocardial infarction (cardiac ischemia prevents the heart from relaxing)

Question 8

Where is S4 heard? What does it sound like?

Answer 8

Heard at the end of diastole immediately before S1

Best heard at the apex of the heart with the bell of the stethoscope

Sounds like ‘a stiff wall’

Question 9

What is a murmur?

Answer 9

A whooshing sound lasting between S1 and S2 Heart sounds

Question 10

What are the causes of a murmur?

Answer 10

Mitral valve regurgitation
Mitral prolapse
Tricuspid valve regurgitation
Ventriculoseptal defect
Ischemic heart disease
Rheumatic fever
Infective endocarditis