Heart Sounds

Question 1

S3

Answer 1

• aka ventricular gallop
• heard best at **apex **
• accentuated by exercise, abd P, flexing knees on abd
• early diastolic filling
• closely follows S2 (high V of blood rushing into ventricles)
• **“Kentucky” **
• almost always **pathological **​
• diseases:
  
  • aortic regurg
  • HF
  • **V overload **

Question 2

S4

Answer 2

• atrial gallop
• late diastolic filling
• stiff (noncompliant) ventricle (ie Hypertrophy)
  
  • turbulent flow = produced by atrial contraction against stiff myocardium
• can be NL in some athletes, usually pathological
  
  • abNL in dec ventricular compliance = HTN, ischemia, AS, cardiomyopathy
• immediately precedes S1
• low pitched (bell)
• “Tennessee”

Question 3

S1

Answer 3

• mitral and tricuspid valves closing
• “lub”
• start of systole

Question 4

S2

Answer 4

• pulmonary and aortic valve close
• physiological split (respiratory)
• wide fixed split (ASD)
• end of systole

Question 5

ejection click

Answer 5

• open semilunar valve (P or A)
• occur early systole at osnet of ejection of blood from ventricle
• “tense” A or P “root”
• may occur in:
  
  • aortic dilatation
  • AS
  • AR
  • PA dilatation
  • PS

Question 6

mid systolic click

Answer 6

• mid systole
• valve doesnt close, balloons up
• MVP
• midsystolic click + late systolic murmur = MVP w/ MR

Question 7

opening snap

Answer 7

• MS
• diseased mitral valve does not fully open during diastole
• mitral leaflets buckle outward to accommodate AV pressure differential
• this causes vibration of leaflets and “snapping” sound
  
  • movement of blood against noncompliant valve
• follows S2, early diastole
• AV valve opening

Question 8

pericardial knock

Answer 8

• diastole
• abrupt sound of blood hitting restricted/noncompliant ventricle as fill
• characteristic of **constrictive pericarditis **