Clinical skills: heart sounds

Question 1

What are the two normal heart sounds?
What sound do they make?
What cardiac event do they represent

Answer 1

S1 (lub): first two valves (tricuspid and mitral) closing
S2 (dub): second two valves (aortic and pulmonary) closing

Question 2

Describe when S1 and S2 occur in relation to systole, diastole, and pulse.

Answer 2

S1: tricuspid and mitral valves close
Systole (ventricular contraction and emptying; pulse is felt)
S2: aortic and pulmonary valves close
Diastole: ventricular relaxation and filling

Question 3

What are the 3 categories of abnormal sounds?

Answer 3

Added sounds
Murmurs
Rubs

Question 4

ADDED SOUNDS
What are they?
What pathophysiology do they often reflect?

Answer 4

S3: ken-tuck-y
S4: ten-nes-see
Heart failure/ventricular hypertrophy

Question 5

MURMURS
What causes murmurs?

Answer 5

Abnormal turbulent flow through the heart/valves, causing abnormal sounds on auscultation

Question 6

MURMURS
What 3 factors about murmurs should you know?

Answer 6

Timing: whether they are systolic or diastolic
Which of the 4 regions is loudest:
Whether/where the murmur radiates

Question 7

5 systolic murmurs?
- How to remember?

Answer 7

Ask - what would cause abnormal flow during systole/ventricular ejection?

Aortic stenosis
Pulmonary stenosis
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect

Question 8

4 diastolic murmurs?

Answer 8

Mitral stenosis
Tricuspid stenosis
Aortic regurgitation
Pulmonary regurgitation

Question 9

AORTIC STENOSIS
- What is the usual cause?
- Is it asymptomatic until severe?
- What do symptoms include?

Answer 9

Aged related calcification of the aortic valve.
Yes
Syncope - not enough blood gets from aorta to brain; angina - not enough blood gets from coronary vessels to heart

Question 10

AORTIC STENOSIS
- Is it a systolic or diastolic murmur?
- Which region is it loudest in?
- Where does it radiate to?
- What sound does it make?

Answer 10

Systolic
Aortic
Carotid arteries
Instead of a lub-dub, a single thud.

Question 11

MITRAL STENOSIS
- What is its usual cause?
- Is it asymptomatic until severe?
- What symptoms does it cause?

Answer 11

Untreated rheumatic heart fever - leads to scarring/thickening of mitral valve.
Yes
Dyspnoea - due to left heart failure

Question 12

MITRAL STENOSIS
- Is it a systolic or diastolic murmur?
- Which region is it loudest in?
- What manoeuvre makes it loudest?
- What sound does it make?

Answer 12

Diastolic
Mitral region
Left lateral decubitus
Like marching - ba-DUM, ba-DUM

Question 13

RUBS
- What causes it?
- What does it sound like?
- Is it easy to hear?
- Is it related to heart sounds?

Answer 13

Pericarditis can lead to fluid buildup in the pericardial sac –> becomes turbulent due to heart movement.
Sounds like the creaking boars of a wooden ship
No - often need to listen for up to a minute to hear it
No - as it’s not within the heart or valves.