SYSTOLIC SOUNDS

Question 1

Occurs shortly after S1, coincident with sudden pathological halting of aortic and pulmonic valves as
they open in early systole

Relatively high pitched with sharp clicking quality

Best heard with diaphragm

Indicates CVD

Answer 1

Early systolic Ejection Sounds

Question 2

Listen for at apex and base

Usually louder at apex and doesn’t alter with respiration

May be a dilated aorta, aortic valve disease from congenital stenosis or bicuspid aortic valve

Answer 2

Aortic Ejection

Question 3

Heard best in 2nd and 3rd left interspaces

When S1 is louder, may be a pulmonic ejection sound

Intensity decreases with inspiration

May be due to dilation of pulmonary artery, pulmonary hypertension or pulmonic stenosis

Answer 3

Pulmonic Ejection

Question 4

Usually caused by mitral valve prolapse (abnormal ballooning of valve into left atrium during
systole)

Clicks usually heard in mid-late systole

Common condition in 2-3% of population

High pitched, and best heard with diaphragm

Often followed by late systolic murmur from mitral regurgitation that crescendos up to S2

Mitral valve prolapse sounds can vary from examination to examination and from different
positions
- Squatting/ Valsalva release delays the click and murmur due to increased venous return
- Standing/ Valsalva strain moves the clicks closer to S1

Answer 4

Systolic Clicks