Heart Sounds

Question 1

S1

Answer 1

mitral and tricuspid valve closure

Loudest at mitral area

Question 2

S2

Answer 2

aortic and pulmonary valve closure

Loudest at left upper sternal border

Question 3

S3

Answer 3

in early diastole during rapid ventricular filling phase

Associated with  filling pressures
(eg, mitral regurgitation, HF) and morecommon in dilated ventricles (but can be
normal in children and young adults).

Question 4

S4

Answer 4

in late diastole (“atrial kick”).

Best heard at apex with patient in left lateral decubitus
position.

High atrial pressure. Associated with ventricular noncompliance (eg, hypertrophy).

Left atrium must push against stiff LV wall.

Consider *abnormal, regardless of patient age